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

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

doi:10.1097/brs.0b013e31829e0d6c

Cited by 5 publications

(12 citation statements)

References 13 publications

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“…Furthermore, compressive bony elements were removed, and the deformity was corrected without any surgical complications resulting from CSF leakage. 22 In the present study, we also had trauma cases, and the transthecal approach was successfully applied in them as well. In addition, most surgeons have recommended primary closure by suturing with or without fibrin glue for treatment of IDs.…”

Section: Discussionmentioning

confidence: 98%

“…Various techniques such as the use of fibrin glue, gel foam, and fat patch with or without suturing have been reported in previous studies, 3,9,11,[18][19][20] and authors of only a few reports recommended the direct repair of anterior durotomy using the transthecal approach. 10,21,22 In our knowledge, no authors compared the transthecal approach with the conservative route to anterior ID repair in a clinical trial design. Therefore, here, the existing literature including case reports, case series, and descriptive or cohort studies was discussed.…”

Section: Discussionmentioning

confidence: 99%

“…Authors of another study found that the use of the posterior transthecal approach was effective and safe in 5 patients with a thoracolumbar fracture. 22 Their study is an example for this claim that the type of disease pathology that requires spine surgery cannot affect the advantages of the transthecal approach. As the findings of their study showed, all 5 patients with fractures and neurological defects successfully received the transthecal approach for dural lacerations repair.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Transthecal Approach With Traditional Conservative Approach for Primary Closure After Incidental Durotomy in Anterior Lumbar Tear

Shahmohammadi

Hajimohammadebrahim-Ketabforoush

Behnaz

et al. 2021

Int J Spine Surg

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Background: Incidental durotomies (IDs) are frequent complications of spinal surgeries which are mostly posterior or lateral. Anterior IDs are rare; however, they may lead to severe complications. We compared the transthecal approach with the conservative approach for primary closure after durotomy in anterior lumbar dural tear to assess the efficacy of these approaches to decrease postsurgical complications and clinical outcomes.Methods: A total of 21 patients undergoing L2-S1 laminectomy with anterior ID were randomly divided into a transthecal group (n ¼ 9) and a conservative group (n ¼ 12) based on the surgical dural closure technique. Postoperative pseudomeningocele, wound infection, rootlet herniation, pneumocephalus, cerebrospinal fluid (CSF) leakage, headache, meningitis, in addition to surgery duration and length of hospitalization were examined and compared in both groups.Results: The frequency of pseudomeningocele and CSF leakage in patients undergoing the transthecal approach was significantly lower than those undergoing the conservative approach (P ¼ .045 and .008, respectively). Furthermore, although the differences in the frequency of meningitis, pneumocephalus, headache, and wound infection were not statistically significant between the 2 groups, the effect sizes of the comparison were obtained as 49.4, 19.8, 7.1, and 2.6, respectively. This indicated that the differences were clinically significant between the 2 groups.Conclusions: We found that the transthecal approach was significantly more successful in managing CSF leakage as well as its complications and clinical outcomes. However, further clinical trials with bigger sample sizes are needed to substantiate this claim.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Comparison of Transthecal Approach With Traditional Conservative Approach for Primary Closure After Incidental Durotomy in Anterior Lumbar Tear

Shahmohammadi

Hajimohammadebrahim-Ketabforoush

Behnaz

et al. 2021

Int J Spine Surg

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Section: Literature Reviewmentioning

confidence: 99%

“…Among the 10 studies yielded by the search strategy describing repair techniques of ventral dural lacerations, a prevalence of primary suturing was noted ( n = 6/10 papers) [ 1 , 3 , 4 , 5 , 6 ]. In five studies a direct suture was preferred even with posterior approaches by opening the dura on its dorsal surface to perform a trans-dural closure [ 3 , 4 , 5 , 6 , 7 ]. A fat graft plugging the dural opening, sutured to its margins, or stitched to the dura adjacent to the defect and covering all the exposed dura, were other strategies adopted for reaching a watertight repair [ 8 , 9 , 10 , 11 ].…”

Section: Literature Reviewmentioning

confidence: 99%

Anterior Dural Tear in Thoracic and Lumbar Spinal Fractures: Single-Center Experience with Coating Technique and Literature Review of the Available Strategies

Lofrese

Visani

Cultrera

et al. 2021

Life

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Differently from the posterior, the anterior dural tears associated with spinal fractures are rarely reported and debated. We document our experience with a coating technique for repairing ventral dural lacerations, providing an associated literature review on the available strategies to seal off such dural defects. A PubMed search on watertight repair techniques of anterior dural lacerations focused on their association with spinal fractures was performed. Studies on animal or cadaveric models, on cervical spine, or based on seal/gelfoam or “not suturing” strategies were excluded. 10 studies were finally selected and our experience of three patients with thoracic/lumbar spinal fractures with associated ventral dural tear was integrated into the analysis of the surgical techniques. Among the described repair techniques for ventral dural lacerations a preference for primary suturing, mostly trans-dural, was noted (n = 6/10 papers). Other documented strategies were the plugging of the dural opening with a fat graft sutured to its margins, or stitched to the dura adjacent to the defect, and the closure of the dural tear with two patches, both trans-dural and epidural. Our coating techniques of the whole dural sac with the heterologous patch were revealed as safe and effective alternatives strategies, even when patch flaps wrapping nerve roots have to be cut and a fat graft has to be stitched in the patch respectively for sealing off antero-lateral and wide anterior dural tears. Compared to all the documented strategies for obtaining a watertight closure of an anterior dural laceration, the coating techniques revealed advantages of preserving neural structures, being adaptable to anterior and antero-lateral dural tears of any size.

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Massive lumbar disc herniation treated with a transdural approach and posterior fusion. A case report

Sono,

Nakatani,

Morizane

et al. 2024

Interdisciplinary Neurosurgery

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

Abstract: 4.

Cited by 5 publications

References 13 publications

Comparison of Transthecal Approach With Traditional Conservative Approach for Primary Closure After Incidental Durotomy in Anterior Lumbar Tear

Comparison of Transthecal Approach With Traditional Conservative Approach for Primary Closure After Incidental Durotomy in Anterior Lumbar Tear

Anterior Dural Tear in Thoracic and Lumbar Spinal Fractures: Single-Center Experience with Coating Technique and Literature Review of the Available Strategies

Massive lumbar disc herniation treated with a transdural approach and posterior fusion. A case report

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