PMC8422415_01
Preoperative computed tomography (CT) and magnetic resonance imaging (MRI). (a) CT revealed a fracture of the L3 vertebra. (b) Sagittal and axial T2-weighted image demonstrated severe dural sac impingement between a protruded bone fragment of the vertebral body and a fractured spinous process, with remarkable compression of cauda equina. The spinous process was fractured and the rootlets were deviated (white arrow).
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F1
The magnetic resonance/computed tomography (MR/CT) studies showed the L3 vertebral body burst fracture fragments protruding into the spinal canal resulting in marked cauda equina compression [Figure 1a and b].
Intraoperative photographs. (a) The dorsal dura mater was found to be lacerated and several damaged rootlets herniated from the point of the ruptured dura mater. (b) The protruded bone fragment was pushed back into the ventral side by transdural tapping using an impactor, while protecting the cauda equina.
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F2
Performing a L3-L4 laminectomy, revealed his dorsal dura was lacerated, with several damaged nerve rootlets herniating through the traumatic durotomy [Figure 2a]. Through the dorsal durotomy, the ventrally extruded L3 body bone fragments were impacted back into the fractured vertebral body [Figures 2b, 3a and b].
Illustrations demonstrating the transdural tapping approach. (a) The dural sac was elevated due to the bone fragment from the ventral side. The dorsal dural sac was injured and the rootlets was deviated (arrow head). (b) Transdural tapping, which involves pushing the bone fragment back into the vertebral body.
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F3
Through the dorsal durotomy, the ventrally extruded L3 body bone fragments were impacted back into the fractured vertebral body [Figures 2b, 3a and b].