Transpedicular Approach for Corpectomy and Circumferential Arthrodesis in Traumatic Lumbar Vertebral Body Burst Fractures: A Retrospective Analysis of Outcome in 35 Patients.

BACKGROUND: Traumatic vertebral burst fractures can be surgically approached via different approaches (anterior/posterior, or combined). Transpedicular approach (TA) is a posterior approach that has the advantage of achieving circumferential arthrodesis via single posterior only approach. The purpose of this study was to analyze our experience with TA in management of traumatic lumbar burst fractures (TLBFs). MATERIALS AND METHODS: All consecutive patients with TLBFs managed with TA over 5 years duration were included in this retrospective study. Correction of kyphotic deformity and change in neurological status were analyzed to assess outcome. Cobb's angle and ASIA grade were used for this purpose. RESULTS: There were 21 males and 14 females. Eight patients had complete (ASIA-A) while 22 had incomplete injury. All patients had a TLICS score >=4. The mean preoperative Cobb's angle was 13.97° that improved to -3.57° postoperatively (mean kyphosis correction-17.54°). None of the patients developed iatrogenic nerve root injury. There was no perioperative mortality. The mean cobb's angle was 1.23° at 39.1 months follow-up. Eight patients developed cage subsidence but none required revision surgery. Postoperatively, 27 (77.1%) patients showed neurological improvement and none deteriorated. The median ASIA score improved from 3 to 5. A fusion rate of 91.4% was observed at last follow-up. CONCLUSIONS: The advantages of TA including sense of familiarity with posterior approach amongst spine surgeons, lesser approach-related morbidity, and results comparable to anterior/combined approaches, make TA an attractive option for managing TLBFs. Although technically difficult, it can be successfully used for circumferential arthrodesis in lumbar region without sacrificing nerve roots.

Transorbital Penetrating Intracranial Injury with an Umbrella Wire Causing Cavernous Internal Carotid Artery Injury and Thrombosis.

BACKGROUND: Transorbital penetrating intracranial injuries, though rare, can have serious consequences. Intracranial penetration can be present even if orbital trauma is trivial. CASE DESCRIPTION: We report an unusual case of transorbital penetrating intracranial injury with umbrella wire, sustained while opening an umbrella, leading to internal carotid artery injury and thrombosis. The patient sustained only ipsilateral third nerve palsy that completely recovered during followup. CONCLUSION: Trivial orbital injuries can be associated with significant intracranial injury in a neurologically intact patient. This case emphasizes the potentially injury-prone opening mechanism of conventional umbrellas. A high index of suspicion is important while evaluating such patients.