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Posterior Transthecal Approach for Repair of Cauda Equina Fibers and Ventral Dural Laceration in Lumbar Burst Fracture: A Novel Surgical Technique

Huang, Abel Po-Hao MD*,§; Chen, Chien-Min MD**; Lai, Hong-Shiee MD, PhD; Chou, Chun-Chih MD; Lu, Daniel C. MD, PhD; Kuo, Lu-Ting MD, PhD*,§; Chuang, Ho-Yu MD††; Tsai, Jui-Chang MD, PhD*,‡

doi: 10.1097/BRS.0b013e31829e0d6c
Surgery

Study Design. Retrospective descriptive study of an innovative surgical technique for patients with thoracolumbar fracture.

Objective. To describe the transthecal approach for patients with thoracolumbar fracture and demonstrate its safety and effectiveness.

Summary of Background Data. The goals of surgery in patients with thoracolumbar fracture include neural decompression, re-establishing stability, reduction of deformity, and repair of dural laceration and the damaged neural elements. The traditional posterior approach may only accomplish the former 3 goals.

Methods. Simply opening the dura during the traditional posterior approach enables accomplishment of all the aforementioned goals, which would not be possible through an anterior or posterior approach alone.

Results. We have successfully performed the transthecal approach in 5 patients with thoracolumbar burst fracture with cauda equina fiber injury. Neural decompression, re-establishing stability, reduction of deformity, and repair of dural laceration and the damaged cauda equina fiber were all achieved in these patients. No complications were noted.

Conclusion. The transthecal approach can be applied to patients with thoracolumbar burst fracture to achieve neural decompression, re-establishing stability, reduction of deformity, and repair of dural laceration and the damaged cauda equina fiber. This approach may be an alternative to combined (circumferential) surgery.

Level of Evidence: 4

Patients with thoracolumbar burst fracture have high probability of cauda equina damage. An innovative transthecal approach, in which the dura is opened during the posterior approach, can accomplish neural decompression, dural and nerve repair, in addition to re-establishing stability and reduction of deformity. This approach is an alternative to circumferential surgery.

*Division of Neurosurgery

Department of Surgery, and

Center for Optoelectronic Medicine, National Taiwan University Hospital, and National Taiwan University College of Medicine, Taipei, Taiwan;

§Division of Neurosurgery

Division of General Surgery, Department of Surgery, National Taiwan University Hospital, Yun-Lin, Taiwan;

Department of Neurosurgery, University of California, Los Angeles, CA;

**Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; and

††Department of Neurosurgery, China Medical University, Bei-Gang Hospital, Yun-Lin, Taiwan.

Address correspondence and reprint requests to Jui-Chang Tsai, MD, PhD, Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital and Center for Optoelectronic Medicine, National Taiwan University College of Medicine, Room 822, 8th Flr, Number 7 Chung-Shan South Road, Taipei, Taiwan; E-mail: jctsai@ntu.edu.tw

Acknowledgment date: January 4, 2013. Revision date: March 20, 2013. Acceptance date: April 1, 2013.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2013 by Lippincott Williams & Wilkins