Laminectomy for acute transverse sacral fractures with compression of the cauda equina: A neurosurgical perspective
Introduction: Optimal management of transverse sacral fractures (TSF) remains inconclusive. These injuries may present with neurological deficits including cauda equina syndrome. We present our series of laminectomy for acute TSF with cauda equina compression. Methods: This was a retrospective chart...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-07-01
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| Series: | World Neurosurgery: X |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590139724001054 |
| _version_ | 1797221739817598976 |
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| author | Devin A. Nikjou Chani M. Taggart Salvatore C. Lettieri Michael R. Collins Owen T. McCabe Layne A. Rousseau Iman Feiz-Erfan |
| author_facet | Devin A. Nikjou Chani M. Taggart Salvatore C. Lettieri Michael R. Collins Owen T. McCabe Layne A. Rousseau Iman Feiz-Erfan |
| author_sort | Devin A. Nikjou |
| collection | DOAJ |
| description | Introduction: Optimal management of transverse sacral fractures (TSF) remains inconclusive. These injuries may present with neurological deficits including cauda equina syndrome. We present our series of laminectomy for acute TSF with cauda equina compression. Methods: This was a retrospective chart review of all patients that underwent sacral laminectomy for treatment of cauda equina compression in acute TSF at our institution between 2007 through 2023. Results: A total of 9 patients (5 male and 4 female) underwent sacral laminectomy to decompress the cauda equina in the setting of acute high impact trauma. Surgeries were done early within a mean time of 5.9 days. All but one patient had symptomatic cauda equina syndrome. In one instance surgery was applied due to significant canal stenosis present on imaging in a patient with diminished mental status not allowing proper neurological examination. Torn sacral nerve roots were repaired directly when possible. All patients regained their neurological function related to the sacral cauda equina on follow up. The rate of surgical site infection (SSI) was 33%. Conclusion: Acute early sacral laminectomy and nerve root repair as needed was effective in recovering bowel and bladder function in patients after high impact trauma and TSF with cauda equina compression. A high SSI rate may be reduced by delaying surgery past 1 week from trauma, but little data exists at this time for clear recommendations. |
| first_indexed | 2024-04-24T13:10:14Z |
| format | Article |
| id | doaj.art-05d0f8ae938f41bab27b88ddd0cf6dd2 |
| institution | Directory Open Access Journal |
| issn | 2590-1397 |
| language | English |
| last_indexed | 2024-04-24T13:10:14Z |
| publishDate | 2024-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | World Neurosurgery: X |
| spelling | doaj.art-05d0f8ae938f41bab27b88ddd0cf6dd22024-04-05T04:41:29ZengElsevierWorld Neurosurgery: X2590-13972024-07-0123100374Laminectomy for acute transverse sacral fractures with compression of the cauda equina: A neurosurgical perspectiveDevin A. Nikjou0Chani M. Taggart1Salvatore C. Lettieri2Michael R. Collins3Owen T. McCabe4Layne A. Rousseau5Iman Feiz-Erfan6Division of Neurosurgery, Valleywise Health Medical Center, Phoenix, AZ, USA; Department of Surgery, Valleywise Health Medical Center, Phoenix, AZ, USA; Arizona State University, School of Biological and Health Systems Engineering, Tempe, AZ, USADepartment of Surgery, Valleywise Health Medical Center, Phoenix, AZ, USA; Division of Trauma, Valleywise Health Medical Center, Phoenix, AZ, USA; Creighton University, School of Medicine Phoenix, Phoenix, AZ, USA; University of Arizona, College of Medicine Phoenix, Phoenix, AZ, USADepartment of Surgery, Valleywise Health Medical Center, Phoenix, AZ, USA; Division of Plastic Surgery, Valleywise Health Medical Center, Phoenix, AZ, USA; Division of Plastic Surgery, Mayo Clinic, Phoenix, AZ, USA; Creighton University, School of Medicine Phoenix, Phoenix, AZ, USA; University of Arizona, College of Medicine Phoenix, Phoenix, AZ, USADepartment of Radiology, Valleywise Health Medical Center, Phoenix, AZ, USA; Creighton University, School of Medicine Phoenix, Phoenix, AZ, USA; University of Arizona, College of Medicine Phoenix, Phoenix, AZ, USADepartment of Surgery, Valleywise Health Medical Center, Phoenix, AZ, USA; Division of Trauma, Valleywise Health Medical Center, Phoenix, AZ, USA; Creighton University, School of Medicine Phoenix, Phoenix, AZ, USA; University of Arizona, College of Medicine Phoenix, Phoenix, AZ, USADepartment of Surgery, Valleywise Health Medical Center, Phoenix, AZ, USA; Division of Urology, Valleywise Health Medical Center, Phoenix, AZ, USA; Creighton University, School of Medicine Phoenix, Phoenix, AZ, USA; University of Arizona, College of Medicine Phoenix, Phoenix, AZ, USADivision of Neurosurgery, Valleywise Health Medical Center, Phoenix, AZ, USA; Department of Surgery, Valleywise Health Medical Center, Phoenix, AZ, USA; Creighton University, School of Medicine Phoenix, Phoenix, AZ, USA; University of Arizona, College of Medicine Phoenix, Phoenix, AZ, USA; Corresponding author. Department of Surgery, Valleywise Health Medical Center, 2601 E Roosevelt Street, Phoenix, AZ, 85008, USA.Introduction: Optimal management of transverse sacral fractures (TSF) remains inconclusive. These injuries may present with neurological deficits including cauda equina syndrome. We present our series of laminectomy for acute TSF with cauda equina compression. Methods: This was a retrospective chart review of all patients that underwent sacral laminectomy for treatment of cauda equina compression in acute TSF at our institution between 2007 through 2023. Results: A total of 9 patients (5 male and 4 female) underwent sacral laminectomy to decompress the cauda equina in the setting of acute high impact trauma. Surgeries were done early within a mean time of 5.9 days. All but one patient had symptomatic cauda equina syndrome. In one instance surgery was applied due to significant canal stenosis present on imaging in a patient with diminished mental status not allowing proper neurological examination. Torn sacral nerve roots were repaired directly when possible. All patients regained their neurological function related to the sacral cauda equina on follow up. The rate of surgical site infection (SSI) was 33%. Conclusion: Acute early sacral laminectomy and nerve root repair as needed was effective in recovering bowel and bladder function in patients after high impact trauma and TSF with cauda equina compression. A high SSI rate may be reduced by delaying surgery past 1 week from trauma, but little data exists at this time for clear recommendations.http://www.sciencedirect.com/science/article/pii/S2590139724001054Fracture of the sacrumCauda equina syndromeSacral laminectomyPelvic traumaNerve root repair |
| spellingShingle | Devin A. Nikjou Chani M. Taggart Salvatore C. Lettieri Michael R. Collins Owen T. McCabe Layne A. Rousseau Iman Feiz-Erfan Laminectomy for acute transverse sacral fractures with compression of the cauda equina: A neurosurgical perspective World Neurosurgery: X Fracture of the sacrum Cauda equina syndrome Sacral laminectomy Pelvic trauma Nerve root repair |
| title | Laminectomy for acute transverse sacral fractures with compression of the cauda equina: A neurosurgical perspective |
| title_full | Laminectomy for acute transverse sacral fractures with compression of the cauda equina: A neurosurgical perspective |
| title_fullStr | Laminectomy for acute transverse sacral fractures with compression of the cauda equina: A neurosurgical perspective |
| title_full_unstemmed | Laminectomy for acute transverse sacral fractures with compression of the cauda equina: A neurosurgical perspective |
| title_short | Laminectomy for acute transverse sacral fractures with compression of the cauda equina: A neurosurgical perspective |
| title_sort | laminectomy for acute transverse sacral fractures with compression of the cauda equina a neurosurgical perspective |
| topic | Fracture of the sacrum Cauda equina syndrome Sacral laminectomy Pelvic trauma Nerve root repair |
| url | http://www.sciencedirect.com/science/article/pii/S2590139724001054 |
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