{"id":"8bd26ded-d159-467d-be75-b29f848c89ee","slug":"thecal-sac-ligation-in-the-setting-of-thoracic-spondyloptosis-with-complete-cord-transection","title":"Thecal sac ligation in the setting of thoracic spondyloptosis with complete cord transection","authors":["Sima Vazquez","John K. Houten","Zehavya T. Stadlan","Jacob D. Greisman","Grigori Vaserman","Eris Spirollari","Tolga Sursal","Jose F. Dominguez","Merritt D. Kinon"],"abstract":"Background: Traumatic spondyloptosis (TS) with complete spinal cord transection and unrepairable durotomy is particularly rare and can lead to a difficult-to-manage cerebrospinal fluid (CSF) leak. Methods: We performed a systematic review of the literature on TS and discuss the management strategies and outcomes of TS with cord transection and significant dural tear. We also report a novel case of a 26-year-old female who presented with thoracic TS with complete spinal cord transection and unrepairable durotomy with high-flow CSF leak. Results: Of 93 articles that resulted in the search query, 13 described cases of TS with complete cord transection. The approach to dural repair was only described in 8 (n = 20) of the 13 articles. The dura was not repaired in two (20%) of the cases. Ligation of the proximal end of the dural defect was done in 15 (75%) of the cases, all at the same institution. One (5%) case report describes ligation of the distal end; one (5%) case describes the repair of the dura with duraplasty; and another (5%) case describes repair using muscle graft to partially reconstruct the defect. Conclusion: Suture ligation of the thecal sac in the setting of traumatic complete spinal cord transection with significant dural disruption has been described in the international literature and is a safe and successful technique to prevent complications associated with persisting high-flow CSF leakage. To the best of our knowledge, this is the first report of thecal sac ligation of the proximal end of the defect from the United States.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/8bd26ded-d159-467d-be75-b29f848c89ee/featured/hero-1781560061496.png","publishDate":"2023-09-01T00:00:00.000Z","doi":"10.25259/SNI_360_2023","categories":["Trauma","Original Article"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2023/09/12527/SNI-14-304.pdf"}