Direct anterior decompression of L4 and L5 nerve root in sacral fractures using the pararectus approach: a technical note.

Häckel, Sonja; Albers, Christoph E.; Bastian, Johannes D.; Hoppe, Sven; Benneker, Lorin M.; Keel, Marius J. B. (2020). Direct anterior decompression of L4 and L5 nerve root in sacral fractures using the pararectus approach: a technical note. Archives of orthopaedic and trauma surgery, 140(3), pp. 343-351. Springer 10.1007/s00402-019-03276-7

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PURPOSE To describe a new surgical technique for neurolysis and decompression of L4 and L5 nerve root entrapment after vertical sacral fractures via the pararectus approach for acetabular fractures, and to present four case examples. PATIENTS AND METHODS We retrospectively evaluated four patients suffering radiculopathy from entrapment of the L4 or L5 nerve root in vertical sacral fractures between January and December 2016. The mean follow-up period after surgery was 18 (range 7-27) months. All patients underwent direct decompression and neurolysis of the L4 and L5 nerve roots via the single-incision, intrapelvic, extraperitoneal pararectus approach. RESULTS In all patients, the L4 and L5 nerve root was successfully visualized and decompressed, proving feasibility of the pararectus approach for this indication. No patient presented with a neural tear. Complete neurologic recovery was present in one patient at last follow-up; two patients had incomplete recovery of their radiculopathy; and one patient had no improvement after nerve root decompression. CONCLUSIONS The pararectus approach allows for sufficient visualisation and direct decompression and neurolysis of the L4 and L5 nerve root entrapped in vertical sacral fractures. Although neurologic recovery was not achieved in all patients in this small case series, the approach may be a suitable alternative to posterior approaches and other anterior approaches such as the lateral window of the ilioinguinal approach.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Orthopaedic Surgery

UniBE Contributor:

Häckel, Sonja; Albers, Christoph; Bastian, Johannes Dominik; Hoppe, Sven; Benneker, Lorin Michael and Keel, Marius

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0936-8051

Publisher:

Springer

Language:

English

Submitter:

Kathrin Aeschlimann

Date Deposited:

25 Oct 2019 16:31

Last Modified:

22 Feb 2020 01:31

Publisher DOI:

10.1007/s00402-019-03276-7

PubMed ID:

31520112

Uncontrolled Keywords:

Anterior approach lumbar plexus L4-nerve root injury L5 nerve root injury Nerve root entrapment Neurolysis Pararectus approach Radiculopathy Vertical sacral fractures

BORIS DOI:

10.7892/boris.134163

URI:

https://boris.unibe.ch/id/eprint/134163

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