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.