Dural Tears in Spinal Burst Fractures: Predictable MR Imaging Findings

Lee, I.S.; Kim, H.J.; Lee, J.S.; Kim, S.-J.; Jeong, Yohan; Kim, D.K.; Moon, Tae Yong

doi:10.3174/ajnr.a1273

Cited by 30 publications

(22 citation statements)

References 30 publications

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“…Concluyeron en que el especialista en imágenes debería sugerir el riesgo elevado de lesión dural ante el compromiso de más de la mitad del canal raquídeo, fragmentos en retropulsión de ángulo agudo, fracturas inestables de lámina asociada y distancia interpedicular amplia en el nivel de la vértebra fracturada. 15 Park y cols. comunicaron resultados similares con las mismas variables, jerarquizando adicionalmente el daño neurológico asociado.…”

Section: Discussionunclassified

“…14 Según Lee y cols., las lesiones durales son posibles cuando hay hallazgos de fractura de lámina, la distancia interpedicular es >28 mm, el radio del canal central es de 0,46 y el ángulo agudo del segmento de retropulsado es de 135°. 15 Yoshiiwa y cols. describen el "cauda equina notch sign" como un signo predecible de atrapamiento de la cauda equina en fracturas de lámina en tallo verde y el tamaño del fragmento del muro retropulsado.…”

Section: Introductionunclassified

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Lesión dural asociada a fracturas de charnela toracolumbar y lumbares con compromiso del muro posterior. Relación con las variables del sistema de clasificación AOSpine. [Thecal sac injury secondary to burst fractures of the thoracolumbar and lumbar spine, and its association with the AOSpine Classification System variables].

Ricciardi

Garfinkel

Carrioli

et al. 2019

Rev. Asoc. Arg. Ort. y Traumatol

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Introducción: Las lesiones del saco dural con atrapamiento de la cauda equina entre los fragmentos óseos pueden estar asociadas con fracturas toracolumbares.Objetivo: Realizar un análisis retrospectivo de las variables clínico-radiográficas y el sistema de clasificación AOSpine y la posibilidad de lesión dural asociada en una serie de fracturas toracolumbares por estallido, tratadas en nuestro Centro.Materiales y Métodos: Estudio retrospectivo, observacional de una serie de pacientes con fracturas toracolumbares con compromiso del muro posterior operados en nuestra institución, entre enero de 2012 y diciembre de 2017.Resultados: Se incluyeron 46 pacientes, 16 casos con lesión del saco dural asociada. Las variables porcentaje de ocupación del canal, distancia interpedicular, ángulo del fragmento retropulsado y déficit neurológico asociado mostraron diferencias estadísticamentesignificativas según la comparación en función de la presencia o ausencia de lesión dural (p = 0,046, p = 0,007, p = 0,046 y p = 0,004, respectivamente).Conclusiones: Según nuestros resultados, la lesión dural traumática podría ser contemplada en la planificación del tratamiento de fracturas toracolumbares ante fragmentos voluminosos del muro posterior con ángulo agudo, compromiso severo del canal raquídeo, distancia interpedicular elevada y daño neurológico asociado, tal como se propone en la bibliografía. AbstractIntroduction: Fractures of the thoracolumbar spine can trigger thecal sac injuries due to the impingement of the cauda equina between bone fragments.Objective: To carry out a retrospective analysis of clinical and radiological variables, the AOSpine Classification System and the possibility of secondary thecal sac injury in a series of thoracolumbar burst fractures treated at our center.Materials and Methods: A retrospective, observational study of a series of patients with thoracolumbar fractures with compromise of the posterior vertebral body wall, who underwent surgery at our center between January 2012 and December 2017.Results: Forty-six patients were included, 16 of which had secondary thecal sac injury. The differences in the variables—percentage of spinal canal involvement, interpedicular distance, angle of the retropulsed fragment, neurological deficit and type C fractures—were statistically significant according to the comparison made with the presence or absence of thecal sac injury (p=0.046, p=0.007, p=0.046, p=0.004, p=0,001 respectively).Conclusions: This study suggests that traumatic thecal sac injury could be suspectedwhen managing burst fractures with prominent fragments in the posterior vertebral body wall, acute angle of the retropulsed fragment, severe compression of the spinal canal, wide interpedicular distance, neurological deficit and fracture displacement (fracturetype C according to the AOSpine Classification System).

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Section: Discussionunclassified

Section: Introductionunclassified

Lesión dural asociada a fracturas de charnela toracolumbar y lumbares con compromiso del muro posterior. Relación con las variables del sistema de clasificación AOSpine. [Thecal sac injury secondary to burst fractures of the thoracolumbar and lumbar spine, and its association with the AOSpine Classification System variables].

Ricciardi

Garfinkel

Carrioli

et al. 2019

Rev. Asoc. Arg. Ort. y Traumatol

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“…However, MRM is not routinely available at all hospitals. Lee et al reported an association between dural tears and certain MRI findings of lamina fractures: an interpedicular distance > 28 mm, a central canal ratio < 0.46, and an acute angle of the retropulsed segment < 135° [ 25 ]. However, the number of participants in the analysis was small and the exact measurement of the central canal diameter ratio is difficult.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Wiltse’s paraspinal approach and open book laminectomy for thoracolumbar burst fractures with greenstick lamina fractures: a randomized controlled trial

Yao

Cai

et al. 2018

J Orthop Surg Res

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BackgroundPosterior short-segment pedicle screw fixation is used to treat thoracolumbar burst fractures. However, no randomized controlled studies have compared the efficacy of the two approaches––the Wiltse’s paraspinal approach and open book laminectomy in the treatment of thoracolumbar burst fractures with greenstick lamina fractures.Materials and methodsPatients with burst fractures of the thoracolumbar spine without neurological deficit were randomized to receive either the Wiltse’s paraspinal approach (group A, 24 patients) or open book laminectomy (group B, 23 patients). Patients were followed postoperatively for average of 27.4 months. Clinical and radiographic data of the two approaches were collected and compared.ResultsOur results showed the anterior segmental height, kyphotic angle, visual analog scale (VAS) score, and Smiley-Webster Scale (SWS) score significantly improved postoperatively in both groups, indicating that both the Wiltse’s paraspinal approach and open book laminectomy can effectively treat thoracolumbar burst fractures with greenstick lamina fractures. The Wiltse’s paraspinal approach was found to have significantly shorter operating time, less blood loss, and shorter length of hospital stay compared to open book laminectomy. However, there were two (2/24) patients in group A that had neurological deficits postoperatively and required a second exploratory operation. Dural tears and/or cauda equina entrapment were subsequently found in four patients in group B and all two patients of neurological deficits in group A during operation. No screw loosening, plate breakage, or other internal fixation failures were found at final follow-up.ConclusionsThe results demonstrated that either of the two surgical approaches can achieve satisfactory results in treating thoracolumbar burst fractures in patients with greenstick lamina fractures. However, if there is any clinical or radiographic suspicion of a dural tear and/or cauda equina entrapment pre-operation, patients should receive an open book laminectomy to avoid a second exploratory operation. More research is still needed to optimize clinical decision-making regarding surgical approach.Electronic supplementary materialThe online version of this article (10.1186/s13018-018-0743-z) contains supplementary material, which is available to authorized users.

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“…Currently, MR myelography or MR cisternography seems to be the investigation of choice. 107,115 Heavily T 2 -weighted images combined with fat-suppression techniques provide excellent contrast between the bright signal of cerebrospinal fluid and the low signal of the adjacent soft tissue, making MRI very sensitive for detecting cerebrospinal fluid accumulation and pseudomeningocele. However, MRI is subject to motion artifact and a small (less than 1 cm) dural tear may still be overlooked.…”

Section: Dural Injurymentioning

confidence: 99%

“…However, if meningitis occurs, it may result in an indefinite opening tract, persistence or worsening of the neurological symptoms, nerve-root entrapment, formation of pseudomeningocele, spinal cord compression, or even transdural spinal cord herniation. [112][113][114][115] Attention should focus on looking for the possibility of dural injury on imaging, because the defect can be primarily repaired at the time of surgery, particularly if it is accessible. A dural tear is usually associated with unstable fracture with a sharp bony fragment impinging on the dura.…”

Section: Dural Injurymentioning

confidence: 99%

Imaging of cervicothoracic junction trauma

Wongwaisayawan¹,

Suwannanon²,

Kaewlai³

2013

RMI

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Cervicothoracic junction trauma is an important cause of morbidity and mortality in trauma patients. Imaging has played an important role in identifying injuries and guiding appropriate, timely therapy. Computed tomography is currently a method of choice for diagnosing cervicothoracic junction trauma, in which the pattern of injuries often suggests possible mechanisms and potential injuries. In this article, the authors describe and illustrate common and uncommon injuries that can occur in the cervicothoracic junction.

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Dural Tears in Spinal Burst Fractures: Predictable MR Imaging Findings

Cited by 30 publications

References 30 publications

Comparison of Wiltse’s paraspinal approach and open book laminectomy for thoracolumbar burst fractures with greenstick lamina fractures: a randomized controlled trial

Imaging of cervicothoracic junction trauma

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