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Case Reports
. 2017 Nov;96(46):e8640.
doi: 10.1097/MD.0000000000008640.

Transforaminal endoscopy in lumbar burst fracture: A case report

Affiliations
Case Reports

Transforaminal endoscopy in lumbar burst fracture: A case report

Yuanyi Wang et al. Medicine (Baltimore). 2017 Nov.

Abstract

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.

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Conflict of interest statement

The authors declared that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Computed tomography showing: Magerl type A3.1 burst fracture and facet disorder (A–K). A bone fragment 7.4 mm in diameter that had breached the spinal canal on the posterior edge of the vertebral body at L2. (L) Damage to the cortices of the left transverse processes of the vertebrae at L1 and L3, and left and right transverse processes of the vertebra at L2 (O). 3D computed tomography showing damage to the right interior facet and spinous process of the vertebra at L1 and the ipsilateral superior facet of the vertebra at L2 (M–O).
Figure 2
Figure 2
C-arm fluoroscopy monitored percutaneous transforaminal endoscopy. Tommy III needle was inserted percutaneously directly to the tip of the superior facet (A). After foraminaplasty, a working cannula was inserted into the foramen to the median part of the spinal canal until the cannula tip reached the posterior-superior end of the L2 vertebra (B, C). The bone fragment was identified and removed using percutaneous transforaminal endoscopy (D–F). When decompression was complete, the nerve root regained circulation (G, H).
Figure 3
Figure 3
Postoperative magnetic resonance imaging (A–C) showing the bone fragments had been completely removed from the spinal canal. Computed tomography of preoperation (D, F) and postoperation (E, G). WA: angle between the superior and inferior endplate of the fractured vertebra; RKA: angle between the tangent of the superior endplate of the cephalad vertebra of the fracture and the tangent of the inferior endplate of the caudal vertebra (D, E). The spinal canal was indicated by dotted lines (F, G).

References

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