Traumatic Bilateral Pars Fracture with Grade-I Spondylolisthesis Treated by Transforaminal (Trans Kambian) Endo Fusion under Epidural Analgesia: A Special Case Report

Abstract

Traumatic spine injuries are common in young and adult population with worlds incidence estimated annual rate in 10.4–130.6 cases per million. We are presenting a case of traumatic bilateral pars fracture with Grade-I spondylolisthesis treated by Endoscopic Transforaminal (Trans Kambian) spine fusion, under epidural analgesia and neuromonitoring. To the best of our knowledge this is a unique scenario reported for the first time in literature. Lumbar fusion although considered as the gold standard for the degenerative spine disease and Spondylolisthesis, Endoscopic Transforaminal (Trans Kambian) lumbar fusion popularly known as Endofusion/Endo-TLIF (Transforaminal lumbar interbody fusion) is a recent and effective minimally invasive option for certain cases. A 30-year male presented with severe low back pain and decreased sensations over dorsum of right foot after a fall of heavy metal pipe on his lower back. (VAS score 9/10). After thorough preop evaluation patient underwent Endoscopic Transforaminal (Trans Kambian) lumbar discectomy and fusion under epidural analgesia, with visualized endplate preparation. Specially designed Titanium Endo-bullet cage was inserted after percutaneous pedicle screw placement under neuromonitoring. Complete reduction of listhesis was achieved with near total relief in pain. Endoscopic TLIF ensures minimal tissue retraction and minimal alteration of the normal anatomy aiding in faster recovery and minimal blood loss. Patient was mobilized and discharged within 24 hours of surgery. We suggest Endo fusion is a safe and effective day care procedure for cases with traumatic bilateral pars fractures.

Keywords

• endoscopic transforaminal lumbar fusion
• pars fracture
• listhesis
• epidural analgesia
• neuromonitoring