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 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.

Iatrogenic ureteral injury secondary to a thoracolumbar lateral revision instrumentation and fusion.

BACKGROUND CONTEXT: Urologic, gynecologic, and colorectal surgical procedures account for most of the iatrogenic ureteral injuries; however, iatrogenic injury secondary to thoracolumbar spinal surgery remains a rare complication. PURPOSE: To report a case of iatrogenic ureteral injury secondary to a thoracolumbar lateral revision instrumentation and fusion managed by percutaneous nephrostomy, ureteroureterostomy, and ureteral stent placement. STUDY DESIGN: Case report. METHODS: A 24-year old female underwent surgical removal of a lumbar plate and broken screw with placement of a unirod spanning L1-L3 through a thoracolumbar exposure with resection of the twelfth rib. RESULTS: On postoperative day 14 she developed left flank pain. Computed tomography scan of the abdomen and pelvis demonstrated a left perinephric fluid collection. After placement of a nephrostomy tube, a retrograde pyelogram with a concomitant antegrade nephrostogram confirmed the diagnosis of ureteral entrapment in the lumbar instrumentation. A spatulated end to end ureteral anastomosis (ureteroureterostomy) was performed over a double J ureteral stent. CONCLUSIONS: Although an iatrogenic ureteral injury secondary to thoracolumbar surgery is rare, it should be included in the differential diagnosis for a patient presenting with flank pain after undergoing lateral thoracolumbar fusion. A urinoma, also an uncommon occurrence, may be a presenting sign. Prompt diagnosis and institution of appropriate corrective surgical procedures may result in successful outcome.