Dural Tears Associated with Burst Fractures of Lumbar Vertebrae: A Series of Three Cases
08 April 2015
04 April 2016
06 March 2017 (online)
Burst fractures of dorsolumbar vertebrae are a common occurrence. There is presence of dural tear in approximately 7.7% of cases, but its diagnosis is commonly missed because of lack of preoperative suspicion. Its preoperative diagnosis is an important adjunct in making a rationale decision for choosing surgical approaches and care during surgery. Magnetic resonance imaging (MRI) is not always helpful in its detection and has its own drawbacks. Out of a total of 27 patients operated for burst fractures of dorsolumbar vertebrae, 3 had a dural tear. Patients who were suspected to have dural tears were taken up for surgical intervention either only posteriorly or along with anterior approach. All three patients had neurologic deficits, widened interpedicular distance, laminar fracture of Gd 1 or more with canal compromise greater than 50%, and wedging with an acute angle. Presence of dural tear with wedging of roots was confirmed intraoperatively. Active effort should be made to detect presence of dural tears if patients of dorsolumbar burst fractures have neurologic deficit, laminar fracture is present, interpedicular distance is widened, and there is severe canal encroachment with an acute angle of the wedge.
Keywordsdorsolumbar vertebrae - burst fractures - dural tear - interpedicular distance - canal compromise - laminar fracture
The article was presented as a poster at NSSI 2014 meet.
- 1 Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine 1983; 8 (08) 817-831
- 2 Keenen TL, Antony J, Benson DR. Dural tears associated with lumbar burst fractures. J Orthop Trauma 1990; 4 (03) 243-245
- 3 Miller CA, Dewey RC, Hunt WE. Impaction fracture of the lumbar vertebrae with dural tear. J Neurosurg 1980; 53 (06) 765-771
- 4 Jensen MC, Kelly AP, Brant-Zawadzki MN. MRI of degenerative disease of the lumbar spine. Magn Reson Q 1994; 10 (03) 173-190
- 5 Morris RE, Hasso AN, Thompson JR, Hinshaw Jr DB, Vu LH. Traumatic dural tears: CT diagnosis using metrizamide. Radiology 1984; 152 (02) 443-446
- 6 Pickett J, Blumenkopf B. Dural lacerations and thoracolumbar fractures. J Spinal Disord 1989; 2 (02) 99-103
- 7 Silvestro C, Francaviglia N, Bragazzi R, Piatelli G, Viale GL. On the predictive value of radiological signs for the presence of dural lacerations related to fractures of the lower thoracic or lumbar spine. J Spinal Disord 1991; 4 (01) 49-53