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. 2021 Mar 23;22(1):300.
doi: 10.1186/s12891-021-04178-9.

Association of the presence and its types of lamina fractures with posterior dural tear and neurological deficits in traumatic thoracic and lumbar burst fractures

Xuchao Shi  1 , Shate Xiang  2 , Bo Dai  1 , Zhennian He  3
Affiliations

Association of the presence and its types of lamina fractures with posterior dural tear and neurological deficits in traumatic thoracic and lumbar burst fractures

Xuchao Shi et al. BMC Musculoskelet Disord. .

Abstract

Introduction: The appropriate and optimal treatment for thoracic and lumbar (TL) burst fractures remains a topic of debate. Characterization of vertical laminar fractures (coronal cross-sectional imaging) is presented in this study to determine the severity and treatment options in TL burst fractures.

Methods: A retrospective evaluation of 341 consecutive patients with TL burst fractures was divided into Group I (whole), Group II (partial), and Group III (intact) based on the vertical laminar fracture morphology from coronal images on computed tomography (CT) scans. The presence of preoperative neurological status was reviewed, and several radiological parameters were measured. In addition, the incidence of dural tears was calculated in patients that underwent a decompression with posterior approach.

Results: In total, 270 lumbar and 71 thoracic burst fractures were analyzed. Compared with the intact group, the two other groups had significantly shorter central canal distance, wider interpedicular distance, and smaller spinal canal area, in particular, Group III. The incidences of preoperative neurological deficits in Groups I to III were 63.0, 22.2, and 6.3%, respectively. The incidences of dural tears in Groups I to III were 25.6, 6.3, and 0%, respectively.

Conclusion: The morphology of vertical laminar fractures observed across the coronal plane was important. Patients with "whole", "partial" and "intact" laminar fractures indicated different severity of TL burst fractures. Due to the high probability of dural tears, decompression is recommended as a primary intervention for patients with "whole" laminar fractures. However, for patients without vertical laminar fractures, minimally invasive technique might be a better choice to avoid approach-related complications.

Keywords: Coronal plane; Dural tears; Spinal lesions; Treatment; Vertical laminar fractures.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Reconstructed three-dimensional CT scan showed the whole laminar fractures directly (a). The coronal CT scan of whole laminar fractures (b). Illustration (c)
Fig. 2
Fig. 2
Reconstructed three-dimensional CT scan showed the partial laminar fractures directly (a). The coronal CT scan of partial laminar fractures (b). Illustration (c)
Fig. 3
Fig. 3
Reconstructed three-dimensional CT scan showing no laminar fracture (a). The coronal CT scan of no laminar fractures (b). Illustration (c)
See this image and copyright information in PMC

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