There has not been universal consensus on the management of traumatic dural tears. This case report and systematic review highlighted the incidence, risk factors, diagnostic clues, surgical management and prognosis of dural rupture in the context of traumatic spinal fractures. A total of 3 databases were included in the literature search: PubMed, Cochrane and Scopus. Search terms included "(dural tear OR dural rupture)" AND "(vertebral fracture OR burst fracture)". Primary outcomes included (I) the incidence of dural tears and etiologies; (II) radiological risk factors; (III) time to surgery and preoperative neurology; (IV) dural repair method; (V) surgical stabilisation; (VI) complications; and (VII) postoperative neurological outcomes. A case of a 57-year-old male with accidental fall from height was presented. Despite being neurologically intact on admission, he developed acute cauda equina syndrome with imaging revealing a three-column L3 fracture with cauda equina compression. He subsequently underwent urgent first-stage posterior decompression and instrumented L2-L4 spinal fusion, during which a traumatic dural rupture caused by L3 lamina fracture was identified and primarily repaired. A second-stage anterior L3 corpectomy and anterior column reconstruction with fusion was performed. For the review, twenty-seven articles, including 8 case reports, were included. Incidence of dural tears after traumatic spinal fractures ranged from 2.9% to 94.7%. Interpedicular distance, presence of whole laminar fractures, central canal diameter and posterior element fractures were radiological indicators for dural lacerations. Most patients presented with incomplete neurological deficit and surgical intervention for most cases involved posterior stabilisation of spine with primary suture repair of the dural laceration. Complications included cerebrospinal fluid (CSF) leakage, pseudomeningoceles and nerve entrapment. Postoperative course was generally satisfactory with up to 61% of patients making complete recovery and returning to function. Dural tears were not uncommon after traumatic spinal injuries, especially in lumbosacral impaction or burst fractures. Radiographic predictors for dural lacerations included interpedicular distance and canal diameter. Current standard of dural repair involves primary suture, while adjunctive techniques (grafts and patches) were only recommended when primary repair was not feasible. The need for immediate surgical treatment is emphasized in patients with incomplete neurological deficits given their recovery potential.

Far-out syndrome is considered a rare spinal disorder characterized by L5 radiculopathy due to extraforaminal stenosis at the lumbosacral junction. Despite advancements in surgical techniques, managing far-out syndrome remains a significant challenge owing to the complex anatomical variations usually associated with the condition. This article reports 2 cases of far-out syndrome resulting from anterolateral vertebral osteophyte formation that underwent anterior decompression. A comprehensive review of the literature is also provided. A 51-year-old man and a 72-year-old woman presented with progressive leg pain and neurogenic claudication associated with hypesthesia over the left L5 dermatome. Radiological findings in both patients revealed entrapment of the L5 nerve root by anterolateral vertebral osteophytes at the anterior exit zone of the foramen. One patient presented with Castellvi Type IV lumbosacral transitional vertebra, and the other patient showed spontaneous facet joint fusion at adjacent segments. We performed anterior-extraperitoneal osteophytectomy using an ultrasonic bone dissector to decompress the extraforaminal stenosis, which resulted in successful resolution of the symptoms and improved neurological status. Both patients remained asymptomatic at the 1-year follow-up. Extraforaminal stenosis at the lumbosacral junction due to anterolateral vertebral osteophytes usually occurs in patients with anatomical abnormalities such as lumbosacral transitional vertebra and adjacent segment fusion. Anterior decompression via extraperitoneal approach is an effective and safe treatment option for far-out syndrome, offering a viable alternative to the conventional posterior approach.

The erector spinae plane block (ESPB) is a regional anesthesia technique increasingly used in recent years for postoperative analgesia in thoracic, abdominal, spinal, and hip surgeries. The adoption of this method has been encouraged by its technical simplicity and a low rate of complications. To date, no case reports have described transient urinary retention following lumbar ESPB. Here, we present the case of a 64-year-old male admitted after a fall that resulted in a right hip fracture. He had previously undergone L5/S1 posterior lumbar interbody fusion, which was unsuccessful, resulting in failed back surgery syndrome (FBSS). To alleviate preoperative lumbosacral pain, bilateral ultrasound-guided ESPB was performed at the L5 transverse process level at the bedside, with 20 mL of 0.2% ropivacaine administered on each side. The procedure was uneventful. Approximately 1 h after the block, the patient experienced a strong urge to void but was unable to urinate. Bedside bladder ultrasonography revealed marked bladder distension, and catheterization yielded 700 mL of urine. By the following morning, with the return of lumbosacral pain sensation, the patient regained spontaneous voiding without other neurological deficits. No recurrence occurred until discharge. This case suggests that in patients with a history of spinal surgery and altered paraspinal anatomy, ESPB may result in unintended blockade due to aberrant spread of local anesthetic into the epidural space. Consequently, a comprehensive preprocedural assessment of spinal anatomy and improved postoperative monitoring of lumbosacral plexus function are advised to ensure early detection and management of this rare complication.

This case highlights the potential effectiveness of posterior sacroiliac joint fusion in pain relief for patients with Bertolotti syndrome. When a patient presents with pain and lumbosacral transitional vertebrae on imaging, there should be a full evaluation for sacroiliac joint pathology, especially at the joint contralateral to the transitional vertebrae.

Pelvic pain syndromes are common and often neuropathic, with pudendal neuralgia being the most recognized. However, other nerves from the sacral and lumbar plexus-including the iliohypogastric, ilioinguinal, genitofemoral, and posterior femoral cutaneous branches-may also contribute to pelvic and genital neuropathic pain. Diagnosis is challenging due to complex pelvic neuroanatomy and overlapping etiologies. MR neurography plays a key role in evaluating affected nerves and musculoskeletal structures, with advanced sequences improving vascular suppression and nerve conspicuity. While ultrasound and CT mainly guide interventions, MR-ultrasound fusion imaging and MR neurography-guided perineural injections provide more accurate, image-guided treatment strategies.