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

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, reestablishing 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