Rx of Sacral Fxs: Decompression

There are no absolute indications for decompression. A neurologic deficit is a necessary but insufficient indication for decompression. Though difficult to determine, the presence of contiguous neural tissue argues for decompression. It would be unrealistic to suppose that a decompressive procedure would restore neurologic function to a transected cauda equina. The problem is that even after MRI study (Image 2), it may require an operative exploration to know whether or not there is neural continuity.

Decompression methodology consists of:

• Focal foraminotomy - for isolated foraminal compromise
• Laminectomy
• Ventral disimpaction - where the compression is secondary to a severe deformity rather than canal compromise with local comminution.

Again, the outcome of such decompression surgery is not clear. There is no compelling evidence in the literature which substantiates its purpose. Patients tend to improve, but as has been noted with thoracolumbar fractures, it is not known whether this is the effect of the decompression or the natural history.