Comparison Between Posterior Short-segment Instrumentation Combined With Lateral-approach Interbody Fusion and Traditional Wide-open Anterior-Posterior Surgery for the Treatment of Thoracolumbar Fractures

Successful treatment of continuous ossification of the posterior longitudinal ligament in the lumbar spine using percutaneous transforaminal endoscopic spinal decompression: a case report

Ossification of the posterior longitudinal ligament (OPLL) of the lumbar spine is rare relative to that of the cervical spine but is often associated with more severe symptoms. Continuous lumbar OPLL is extremely rare. We herein describe a 48-year-old Chinese woman with lumbar spinal stenosis caused by continuous OPLL. She presented with a 5-year history of lower back pain and intermittent claudication. We performed percutaneous transforaminal endoscopic decompression by the posterolateral approach to achieve adequate decompression of the spinal canal up to the lower 1/3 level (0.9 cm) of the L1 vertebral body and down to the upper 1/2 level (1.3 cm) of the L2 vertebral body. After surgery, the patient's neurological function substantially improved, and her visual analog scale scores for the lower back and both lower extremities and her Oswestry disability index were significantly lower than those in the preoperative period. During the 12-month clinical follow-up period, the patient's neurological function was fully restored, and she regained her ability to walk normally. No surgery-related complications were observed. This case report describes a novel surgical approach that may be an effective treatment alternative for continuous lumbar OPLL.

Percutaneous pedicle screw fixation combined with transforaminal endoscopic spinal canal decompression for the treatment of thoracolumbar burst fracture with severe neurologic deficit: A case report

RATIONALE

The most common fractures of the spine are associated with the thoracolumbar junction (T10-L2). And burst fractures make up 15% of all traumatic thoracolumbar fractures, which are often accompanied by neurological deficits and require open surgeries. Common surgeries include either anterior, posterior or a combination of these approaches. Here, we report the first attempt to treat thoracolumbar burst fracture (TLBF) with severe neurologic deficits by percutaneous pedicle screw fixation (PPSF) and transforaminal endoscopic spinal canal decompression (TESCD).

PATIENT CONCERNS

A 46-year-old Chinese woman suffered from severe lower back pain with grade 0 muscle strength of lower limbs, without any sensory function below the injury level, with an inability to urinate or defecate after a motor vehicle accident. Imaging studies confirmed that she had Magerl type A 3.2 L1 burst fracture.

DIAGNOSES

Burst fracture at L1.

INTERVENTIONS

The patient underwent PPSF at the level of T12 to L2, but her neurological function did not fully recover after the operation. One week after the injury, we performed TESCD on her.

OUTCOMES

There was an immediate improvement in her neurological function in just 1 day after 2-stage operation. During the 6-month follow-up period, her neurological functions gradually recovered, and she was able to defecate and urinate. At the last follow-up visit, her spinal cord function was assessed to be at Frankel grade D.

LESSONS

PPSF plus TESCD can achieve complete spinal cord decompression, promote neurological recovery, and is therefore an effective method for the treating lumbar burst fractures with severe neurologic deficits.

Transforaminal endoscopy in lumbar burst fracture: A case report

RATIONALE

Lumbar burst fractures are frequent injury resulting from high-energy trauma, and the patients suffer from pain and the neurologic dysfunction. Although minimally invasive techniques have advanced rapidly, it was the first time to apply transforaminal endoscopic combined with percutaneous pedicle screw fixation to treatment of lumbar burst fractures.

PATIENT CONCERNS

A 33-year-old man underwent Magerl type A3.1 burst fracture at L2 and compression fractures at L3 due to falling from a height with severe lower back pain, sensory loss, and atony of the right leg.

DIAGNOSES

Burst fracture at L2, compression fractures at L3.

INTERVENTIONS

The patient was presented to 1-stage operation of percutaneous pedicle screw fixation at L1, L2, L3, and L4 instead of delayed posterior open surgery. At 1 week after injury, the 2-stage operation with a percutaneous transforaminal endoscopic was undertaken for decompression.

OUTCOMES

No matter the function of nerve and imaging findings, all got ideal recoveries in just 3 days after 2-stage operation. At the 3-month follow-up, there was no loss of sagittal plane alignment, and spinal cord compression was completely relieved. The patient regained near-full neurologic function postoperatively.

LESSONS

A minimally invasive surgery (ie, transforaminal endoscopic combined with percutaneous pedicle screw fixation) for the treatment of Magerl type A3.1 burst fracture at lumbar was feasible. In addition, the key to the recovery of neurological function is the complete and effective decompression of spinal.

Minimally Invasive Versus Open Laminectomy/Discectomy, Transforaminal Lumbar, and Posterior Lumbar Interbody Fusions: A Systematic Review

Minimally invasive spine surgeries (MISS) are becoming increasingly favored as alternatives to open spine procedures because of the reduced blood loss, postoperative pain, and recovery time. Studies have shown mixed results regarding the efficacy and safety of minimally invasive procedures compared to the traditional, open counterparts. The objectives of this systematic analysis are to compare clinical outcomes between the three MISS and open procedures: (1) laminectomy/discectomy, (2) transforaminal lumbar interbody fusion (TLIF), and (3) posterior lumbar interbody fusion (PLIF). The Cochrane and PubMed databases were queried according to the preferred reporting items for systematic review and meta-analyses (PRISMA) statement. The primary outcome measures included the visual analog scale (VAS), the Oswestry disability index (ODI), and blood loss. A total of 32 studies were included in the analysis. Of the three procedures investigated, only MISS TLIF showed significantly improved VAS for leg pain (p = 0.02), ODI (p = 0.05), and reduced blood loss (p = 0.005). MISS-laminectomy/discectomy, TLIF, and PLIF appear to be similar in terms of postoperative pain and perioperative blood loss. MISS TLIF is perhaps more effective in specific outcome measures and results in less intraoperative blood loss than open TLIF.