Relationship between Lamina Fractures and Dural Tear in Low Lumbar Burst Fractures

Ki-Chan An; Dae Hyun Park; Yong-Wook Kwon

doi:10.12671/jkfs.2011.24.3.256

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An, Park, and Kwon: Relationship between Lamina Fractures and Dural Tear in Low Lumbar Burst Fractures

Original Article

Journal of the Korean Fracture Society

Journal of the Korean Fracture Society 2011; 24(3): 256-261.

Published online: 15 July 2011

DOI: https://doi.org/10.12671/jkfs.2011.24.3.256

Relationship between Lamina Fractures and Dural Tear in Low Lumbar Burst Fractures

Ki-Chan An, M.D., Dae Hyun Park, M.D.^*, Yong-Wook Kwon, M.D.

Department of Orthopedic Surgery, Pusan Paik Hospital, College of Medicine, Inje University, Busan, Korea.

^*Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea.

Address reprint requests to: Dae Hyun Park, M.D. Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, 149, Sangil- dong, Gangdong-gu, Seoul 134-727, Korea. Tel: 82-2-440-6152, Fax: 82-2-440-7494, 97111033@hanmail.net

Received 14 January 2010 Revised 21 December 2010 Accepted 18 April 2011

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the relationship between the greenstick laminar fractures and the dural tear in low lumbar burst fractures and their optimal treatment.

Materials and Methods

We enrolled 51 patients (52 cases) who had been diagnosed with low lumbar burst fracture from June 2003 to May 2007. The average age was 39 years (range, 22 to 58), 30 male patients (58.8%), and 21 female patients (41.2%). Average follow-up periods was 19 months (range, 11 to 45). Lumbar CT scan were taken 1 mm slices in precision for all patients. We judged it incomplete fracture if lumbar CT scans show loss of cortical continuity over 3 slices if there is an aggrement of two among one radiologist and two orthopaedic surgeons reached a consensus. Dural tear and entrapment of nerve root were confirmed intraoperatively by the senior surgeon.

Results

In 52 burst fractures, complete lamina fractures occurred in 21 cases and there were green stick laminar fractures in 14 cases. Neurologic defect has been found in 12 cases, 5 (63%) from complete laminar fractures and 3 (37%) from green stick laminar fractures. Dural tears has been detected in 9 cases (26%), 4 (19%) from complete laminar fractures and 5 (36%) from green stick laminar fractures.

Conclusion

Dural tear and nerve root entrapment can be accompanied in patients with green stick fracture. There is necessary to consider the possibility of dural tear and nerve root entrapment before operation and to indentify carefully to the presence of nerve root entrapment during operation.

Keywords: Burst fracture, Lamina fracture, Dural tear, Nerve root entrapment, CT

Figures and Tables

Fig. 1

Axial (A) and sagittal (B) CT scans show L3 burst fracture with green stick laminar fracture (arrow) in 22 year-old man who fell from height. Initial Frankel grade was D.

Fig. 2

Axial (A) and sagittal (B) CT scans show L2 burst fracture with greenstick laminar fracture and 70% of spinal canal occlusion (arrow) in 49 year-old man who had motor vehicle accident. Initial Frankel grade was C.

Fig. 3

Axial (A) and sagittal (B) CT scans show L3 burst fracture with greenstick laminar fracture and 50% of spinal canal occlusion (arrow) in 53 year-old man who fell from height. Initial Frankel grade was D.

Table 1

Prevalence of laminar complete and greenstick fracture in low lumbar burst fractures

Table 2

Prevalence of neurologic symptom or deficit in low lumbar burst fractures

Table 3

Prevalence of dural sac tears in low lumbar burst fractures

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