The Journal of Bone and Joint Surgery, Vol 71, Issue 7 1044-1052, Copyright © 1989 by Journal of Bone and Joint Surgery, Inc
Dural laceration occurring with burst fractures and associated laminar fractures
FP Cammisa, FJ Eismont and BA Green
University of Miami/Jackson Memorial Hospital Center, Florida.
The cases of sixty patients in whom a burst fracture of a thoracic or
lumbar vertebral body had been treated with posterior instrumentation and
arthrodesis less than two weeks after the injury were retrospectively
reviewed. Thirty of the patients had an associated laminar fracture. Eleven
of the thirty, all of whom had a lumbar fracture and a preoperative
neurological deficit, were noted at operation to have dural laceration. In
four of the patients who had dural laceration, neural elements were
entrapped between the fragments from the laminar fracture. None of the
remaining thirty patients who did not have a laminar fracture had dural
laceration (p = 0.0002). Univariate and multivariate statistical analysis
revealed no significant association of the dural laceration with the
patients' age or sex, or with the radiographic characteristics of the
spine. There was a significant association between dural laceration and
neurological deficit (p = 0.0001). In our series, the presence of a
preoperative neurological deficit in a patient who had a burst fracture and
an associated laminar fracture was a sensitive (100 per cent) and specific
(74 per cent) predictor of dural laceration. The presence of this fracture
pattern and an associated neurological deficit also predicted a risk of
dural laceration with entrapped neural elements. This information may
influence decisions as to whether an anterior or a posterior surgical
approach should be used in such patients.
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