Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Predictable Factors for Dural Tears in Lumbar Burst Fractures with Vertical Laminar Fractures

  • Park, Jin-Kyu (Department of Neurosurgery, School of Medicine, Kyungpook National University) ;
  • Park, Jin-Woo (Department of Neurosurgery, Charmjoeun Hospital) ;
  • Cho, Dae-Chul (Department of Neurosurgery, School of Medicine, Kyungpook National University) ;
  • Sung, Joo-Kyung (Department of Neurosurgery, School of Medicine, Kyungpook National University)
  • Received : 2011.03.09
  • Accepted : 2011.07.01
  • Published : 2011.07.28
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : The purpose of the present study was to determine the incidence of dural tears and predictable factors suggesting dural tears in patients who had lumbar burst fractures with vertical laminar fractures. Methods : A retrospective review was done on thirty-one patients who underwent operative treatment for lumbar burst fractures with vertical laminar fractures between January 2003 and December 2008. All patients were divided into two groups according to existence of dural tears, which were surgically confirmed; 21 patients with dural tears and 10 patients without dural tears. Clinical and radiographic findings were analyzed for their association with dural tears. Results : Among a total of 31 patients, dural tears were detected in 21 (67%) patients. A preoperative neurological deficits and mean separation distances of the edges in laminar fractures were found to be the reliable factors of dural tears (p=0.001 and 0.002, respectively). Decreased ratio of the central canal diameter and interpedicular distance were also the reliable factors suggesting dural tears (p=0.006 and 0.015, respectively). However, dural tears showed no significant association with age, sex, level of injury, absence of a posterior fat pad signal, the angle of retropulsed segment, or site of laminar fracture. Conclusion : Our study of lumbar burst fracture combined laminar fracture revealed that dural tears should be ruled out in cases of a preoperative neurological deficits, wide separation of the laminar fracture, severe canal encroachment, and wider interpedicular distance.

Keywords

References

  1. Andreychik DA, Alander DH, Senica KM, Stauffer ES : Burst fractures of the second through fifth lumbar vertebrae. Clinical and radiographic results. J Bone Joint Surg Am 78 : 1156-1166, 1996 https://doi.org/10.2106/00004623-199608000-00005
  2. Atlas SW, Regenbogen V, Rogers LF, Kim KS : The radiographic characterization of burst fractures of the spine. AJR Am J Roentgenol 147 : 575-582, 1986 https://doi.org/10.2214/ajr.147.3.575
  3. Atlas SW, Regenbogen V, Rogers LF, Kim KS : The radiographic characterization of burst fractures of the spine. AJR Am J Roentgenol 147 : 575-582, 1986 https://doi.org/10.2214/ajr.147.3.575
  4. Bohlman HH, Eismont FJ : Surgical techniques of anterior decompression and fusion for spinal cord injuries. Clin Orthop Relat Res : 57-67, 1981
  5. Bosacco SJ, Gardner MJ, Guille JT : Evaluation and treatment of dural tears in lumbar spine surgery : a review. Clin Orthop Reat Res : 238-247, 2001
  6. Bridwell KH : Low lumbar (L3-L4-L5) burst fractures in Floman Y, Farcy JPC, Argenson C (eds) : Thoracolumbar spine fracture. New York : Raven,1993, pp 223-234
  7. Cammisa FP Jr, Eismont FJ, Green BA : Dural laceration occurring with burst fractures and associated laminar fractures. J Bone Joint Surg Am 71 : 1044-1052, 1989 https://doi.org/10.2106/00004623-198971070-00011
  8. Carl AL, Matsumoto M, Whalen JT : Anterior dural laceration caused by thoracolumbar and lumbar burst fractures. J Spinal Disord 13 : 399-403, 2000 https://doi.org/10.1097/00002517-200010000-00005
  9. Choe IS : Therapeutic results of CSF leakage due to unintended incidental durotomy in spine surgery. J Korean Neurosurg Soc 35 : 574-578, 2004
  10. Denis F, Burkus JK : Diagnosis and treatment of cauda equina entrapment in the vertical lamina fracture of lumbar burst fractures. Spine 16 : S433-S439, 1991 https://doi.org/10.1097/00007632-199108001-00024
  11. Jelsma RK, Kirsch PT, Rice JF, Jelsma LF : The radiographic description of thoraco-lumbar burst fractures. Surg Neurol 18 : 230-236, 1982 https://doi.org/10.1016/0090-3019(82)90328-7
  12. Kahamba JF, Rath SA, Antoniadis G, Schneider O, Neff U, Richter HP : Laminar and arch fractures with dural tear and nerve root entrapment in patients operated upon for thoracic and lumbar spine injuries. Acta Neurocir (Wien) 140 : 114-119, 1998 https://doi.org/10.1007/s007010050071
  13. Keene JS, Fischer SP, Drummond DS : The neurological consequences of post traumatic impingement. Presented at the 52nd Annual Meeting of American Academy of Orthopaedic Surgeons, Las Vegas, Mevada
  14. Keenen TL, Antony J, Benson DR : Dural tears associated with lumbar burst fractures. J Orthop Trauma 4 : 243-245, 1990 https://doi.org/10.1097/00005131-199004030-00001
  15. Krudy AG : MR myelography using heavily T2-weighted fast spin-echo pulse sequences with fat presaturation. AJR Am J Roentgenol 159 : 1315-1320, 1992 https://doi.org/10.2214/ajr.159.6.1442408
  16. Lee IS, Kim HJ, Lee JS, Kim SJ, Jeong YJ, Kim DK, et al. : Dural tears in spinal burst fractures: predictable MR imaging findings. AJNR Am J Neuroradiol 30 : 142-146, 2009 https://doi.org/10.3174/ajnr.A1720
  17. Marciello MA, Flanders AE, Herbison GJ, Schaefer DM, Friedman DP, Lane JI : Magnetic resonance imaging related to neurologic outcome in cervical spinal cord injury. Arch Phys Med Rehabil 74 : 940-946, 1993
  18. Miller CA, Dewey RC, Hunt WE : Impaction fracture of the lumbar vertebrae with dural tear. J Neurosurg 53 : 765-771, 1980 https://doi.org/10.3171/jns.1980.53.6.0765
  19. Morris RE, Hasso AN, Thompson JR, Hinshaw DB Jr, Vu LH : Traumatic dural tears: CT diagnosis using metrizamide. Radiology 152 : 443-446, 1984 https://doi.org/10.1148/radiology.152.2.6739812
  20. Osaka K, Handa H, Watanabe H : Traumatic intrathoracic meningocele (Traumatic subarachnoid-pleural fistula). Surg Neurol 15 : 137-140, 1981 https://doi.org/10.1016/0090-3019(81)90033-1
  21. Ozturk C, Ersozlu S, Aydinli U : Importance of greenstick lamina fractures in low lumbar burst fractures. Int Orthop 30 : 295-298, 2006 https://doi.org/10.1007/s00264-005-0052-0
  22. Pau A, silvestro C, Carta F : Can lacerations of the thoraco-lumbar dura be predicted on the basis of radiological patterns of the spinal fractures? Acta Neurochir (Wien) 129 : 186-187, 1994 https://doi.org/10.1007/BF01406502
  23. Pickett J, Blumenkopf B : Dural lacerations and thoracolumbar fractures. J Spinal Disord 2 : 99-103, 1989
  24. Schmidek HH, Gomes FB, Seligson D, McSherry JW : Management of acute unstable thoracolumbar (T-11-L-1) fractures with and without neurological deficit. Neurosurgery 7 : 30-35, 1980 https://doi.org/10.1227/00006123-198007000-00005

Cited by

  1. Dynamics of interpedicular widening in spinal burst fractures: an in vitro investigation vol.14, pp.9, 2011, https://doi.org/10.1016/j.spinee.2014.01.058
  2. Risk Factors for Dural Tears in Thoracic and Lumbar Burst Fractures Associated With Vertical Laminar Fractures vol.43, pp.11, 2011, https://doi.org/10.1097/brs.0000000000002425
  3. A Randomized Controlled Trial of Topical Application of Tranexamic Acid in Patients with Thoracolumbar Spine Trauma Undergoing Long-Segment Instrumented Posterior Spinal Fusion vol.13, pp.1, 2019, https://doi.org/10.31616/asj.2018.0125