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

IntroductionThe 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.MethodsA 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.ResultsIn 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.ConclusionThe 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.

Automated summary

The study retrospectively evaluated 341 consecutive patients with thoracic and lumbar burst fractures, categorizing them into whole, partial, and intact groups based on vertical laminar fracture morphology from coronal CT scans. Different severity of TL burst fractures was observed in patients with different types of laminar fractures, indicating the importance of vertical laminar fracture morphology in treatment decisions. Despite the higher incidence of dural tears in patients with whole laminar fractures, minimally invasive techniques may be a better choice for those without vertical laminar fractures to avoid approach-related complications.