M Mok James, A Strelzow Jason, L Vallina Van, P Zebala Lukas
Department of Orthopaedic Surgery, NorthShore University HealthSystem, Skokie, Illinois, USA.
Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, Illinois, USA.
Spine Surg Relat Res. 2022 Apr 12;6(5):563-568. doi: 10.22603/ssrr.2021-0097. eCollection 2022 Sep 27.
Sacroplasty is a minimally invasive treatment option for severe pain due to sacral insufficiency fracture. Cement leakage is a known risk of sacroplasty. Despite the elevated risk to the L5 nerve root and lumbosacral trunk from cement leakage anterior to the sacral ala, there are no reports regarding surgical management of this complication.
We describe an anterior retroperitoneal transpsoas approach to the sacral ala to remove cement leakage causing acute L5 radiculopathy in a 57-year-old gentleman who had undergone sacroplasty for sacral insufficiency fracture (Denis zone 1). The approach provides rapid and excellent visualization of the sacral ala without manipulation of the iliac vessels.
We recommend that surgery be considered in a timely fashion, to utilize neuromonitoring, and that surgeons be aware of the considerable variability of the neurologic structures that will be encountered, which is described in this technical note.
骶骨成形术是治疗骶骨不全骨折所致严重疼痛的一种微创治疗选择。骨水泥渗漏是骶骨成形术已知的风险。尽管骶骨翼前方的骨水泥渗漏会增加L5神经根和腰骶干受损的风险，但尚无关于该并发症手术处理的报道。
我们描述了一种经腹膜后经腰大肌入路至骶骨翼，用于清除骨水泥渗漏的方法。该方法用于一名57岁男性患者，其因骶骨不全骨折（Denis 1区）接受了骶骨成形术，骨水泥渗漏导致急性L5神经根病。该入路可快速、清晰地显露骶骨翼，且无需操作髂血管。
我们建议及时考虑手术，采用神经监测，并且外科医生应了解本技术要点中所描述的术中将会遇到的神经结构的显著变异性。
