Clinical application of the paraspinal erector approach for spinal canal decompression in upper lumber burst fractures

Abstract

ObjectivePercutaneous pedicle screw fixation is commonly used for upper lumber burst fractures. The direct decompression remains challenging with this minimally invasive surgery. The objective was to evaluate a novel paraspinal erector approach for effective and direct decompression in patients with canal compromise and neurologic deficit.MethodPatients (n = 21) with neurological deficiency and Denis B type upper lumbar burst fracture were enrolled in the study, including 14 cases in the L1 and 7 cases in the L2. The patients underwent removal of bone fragments from the spinal canal through intervertebral foramen followed by short-segment fixation. Evaluations included surgery-related, such as duration of surgery and blood loss, and 12-month follow-up, such as the kyphotic angle, the height ratio of the anterior edge of the vertebra, the ratio of sagittal canal compromise, visual analog scale (VAS), Oswestry Disability Index (ODI), and Frankel scores.ResultsAll patients achieved direct spinal canal decompression using the paraspinal erector approach followed by percutaneous pedicle screw fixation. The mean operation time (SD) was 173 (23) min, and the mean (SD) blood loss was 301 (104) ml. Significant improvement was noted in the kyphotic angle, 26.2 ± 8.7 prior to operation versus 9.1 ± 4.7 at 12 months after operation (p <0.05); the height ratio of the anterior edge of the injured vertebra, 60 ± 16% versus 84 ± 9% (p <0.05); and the ratio of sagittal canal compromise, 46.5 ± 11.4% versus 4.3 ± 3.6% (p <0.05). Significant improvements in VAS (7.3 ± 1.2 vs. 1.9 ± 0.7, p <0.05), ODI (86.7 ± 5.8 vs. 16.7 ± 5.1, p <0.05), and Frankel scores were also noted.ConclusionsThe paraspinal erector approach was effective for direct spinal canal decompression with minimal injury in the paraspinal muscles or spine. Significant improvements in spinal function and prognostics were achieved after the percutaneous pedicle screw fixation.

RETRACTED ARTICLE: Percutaneous pedicle screw fixation combined with selective transforaminal endoscopic decompression for the treatment of thoracolumbar burst fracture

“…The controversy mainly focuses on whether it is necessary to combine it with spinal canal incision and decompression and how to choose the decompression method. Because PPSF is effective for TLBF treatment in terms of fixation and reduction, it can reset the bone mass protruding into the spinal canal, to a certain extent, and in some cases, good spinal canal recovery can be achieved without spinal canal decompression [10]. Therefore, some surgeons believe that TLBF can be treated by posterior pedicle screw fixation alone without spinal canal incision and decompression [11,12].…”

Percutaneous versus open posterior stabilization and decompression in AOSpine-type A3 thoracolumbar fractures with neurological deficit

“…Current surgical options for TLF with neurological deficits include posterior pedicle screw fixation combined with posterior laminectomy, anterior fixation combined with anterior direct decompression, and anterior decompression and fixation combined with posterior fixation [ 3 , 5 , 6 , 12 – 14 ]. Although fixation and decompression via the anterior approach can achieve anterior column support and direct decompression [ 15 ], it is less used because posterior transpedicular approaches to the anterior column are safer and easier [ 16 ].…”

Three-dimensional architecture of the neurovascular and adipose zones of the upper and lower lumbar intervertebral foramina: an epoxy sheet plastination study

“…Some studies limit the IVF to the space between the lateral and medial borders of the pedicle. 20,34 Because the posterolateral IVD and the lateral border of the IVJ are far lateral to the pedicle, in the present study we defined the lateral boundary of the IVF as a sagittal plane that passes from the posterolateral margin of the vertebral body to the most lateral aspect of the IVJ. Its parallel sagittal plane along the most lateral aspect of the dural sac was defined as the medial boundary of the IVF.…”