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

Abstract

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.

Figure 1

Imaging of the patient on admission. On the sagittal (A) and axial (B) computed tomography, the retropulsion of bone fragments into the spinal canal. Magnetic resonance imaging of T2-weighted image (C) and (D) also showed that bone fragments had retropulsed into the spinal canal and dural sac was severely compressed.

Figure 2

The images of the patient were re-examined on the first day after PPSF. The first postoperative radiograph showed satisfactory position of the internal fixation system (A and D). The axial (B) and sagittal (C) of the computed tomography showed the size of fracture fragments in the spinal canal decreased.

Figure 3

The distal end of the cannula was extended to the median part of the spinal canal (A) and the cannula tip reached the posterior–superior end of the L1 vertebra (B), as visualized by C-arm fluoroscopy. The remaining fracture fragments in the spinal canal can be seen under the transforaminal endoscope (C and D).

Figure 4

The images of the patients were re-examined on the 3rd day after the second operation. The sagittal (A) and axial (B) of computed tomography showed no residual bone fragments in the spinal canal and complete decompression of the spinal cord.