• Abel Po-Hao Huang, Chien-Min Chen, Hong-Shiee Lai, Chun-Chih Chou, Daniel C Lu, Lu-Ting Kuo, Ho-Yu Chuang, and Jui-Chang Tsai.
• Department of Surgery, National Taiwan University College of Medicine, Taipei, Taiwan.
• Spine. 2013 Aug 15;38(18):E1156-61.

Study DesignRetrospective descriptive study of an innovative surgical technique for patients with thoracolumbar fracture.ObjectiveTo describe the transthecal approach for patients with thoracolumbar fracture and demonstrate its safety and effectiveness.Summary Of Background DataThe 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.MethodsSimply 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.ResultsWe 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.ConclusionThe 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 Evidence4.

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