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Beitragstitel L4/L5 Nerve Root Compression After Vertical Sacral Fracture: An Indication for the Pararectus Approach?
Beitragscode P029
Autoren
  1. Sonja Häckel Inselspital, Bern University Hospital, University of Bern Vortragender
  2. Sven Hoppe Inselspital, Bern University Hospital
  3. Johannes Dominik Bastian Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
  4. Christoph Emanuel Albers Universitätsklinik für Orthopädische Chirurgie und Traumatologie, Inselspital Bern
  5. Paul Gilbert Fairhurst Inselspital Bern
  6. Lorin Michael Benneker Ortho-Spine, Sonnenhof Spital
  7. Marius J.B. Keel Trauma Zentrum Hirslanden
Präsentationsform Poster
Themengebiete
  • A03 - Wirbelsäule
Abstract Objective: Compression of the L4 and/or L5 nerve roots after vertical sacrum fracture may occur as a direct trauma consequence or postoperatively, as a result of the anteriorly dislocated fracture fragments. In this case series we show the decompression of the L4 and/or L5 nerve root via the intrapelvic, extraperitoneal Pararectus approach.

Methods: A retrospective analysis of a total of four patient cases with a mean age of 35 years (range: 18 - 49 years) and a follow-up period of 7 - 27 months was performed. All patients had a transforaminal longitudinal sacral fracture, which caused a radiculopathy. All patients underwent neurolysis via Pararectus approach. The extension of this approach, which we have established for the osteosynthesis of acetabular fractures, allows a direct visualization of the nerve roots in their course over the sacral ala.

Results: In all cases, dislocated osseous fragments of the sacrum that resulted in L4 and/or L5 nerve root compression could be successfully removed via the Pararectus approach. In one patient, L4/L5 nerve root compression occurred as a direct trauma consequence. After decompression, this patient completely recovered from the neurological deficit (dorsiflexion of the great toe M2/5 improved postoperative to M5/5). In the other three patients, the L4 and/or L5 radiculopathy appeared after spinopelvic stabilization. In two of the three patients, a slight improvement in neurological deficits was observed after L4/L5 nerve root decompression. Two patients improved with persisting neurological deficits (Patient 2: Dorsiflexion of the foot and great toe M0/5 improved to M3/5; Patient 3: dorsiflexion of the foot still M0/5, dorsiflexion of the great toe M0/5 improved to M3/5). The remaining patient showed no changes of the symptoms (dorsiflexion of the foot and great toe M0/5).

Conclusion: The fracture fragments of the sacrum caused a radiculopathy of the nerve roots L4 and/or L5. The Pararectus approach allows neurolysis via direct visualization of the nerve roots as they pass over the sacrum, and is a suitable alternative to other anterior approaches, such as the first window of the ilioinguinal approach, for this indication.