Importance of greenstick lamina fractures in low lumbar burst fractures

Abstract

Lumbar burst fractures (L3-L5) represent a small percentage of all spinal fractures. The treatment of fractures involving the lumbar spine has been controversial. Lamina fractures may be complete or of the greenstick type. Dural tears and nerve root entrapment may accompany these lamina fractures. The aim of this retrospective study was to determine the incidence of dural tear in patients who had lumbar burst fractures with greenstick lamina fractures and the importance of these lamina fractures when choosing the optimum treatment. Twenty-six patients with 28 lumbar burst fractures were treated from 1995 through 2002. The average follow-up was 60 months (range 32-110 months). The male to female ratio was 21:5 and the mean age was 37 years (17-64). Dural tear was detected in seven (25%) out of 28 burst fractures. The functional outcome of the entire study group was assessed using the Smiley-Webster Scale. Good to excellent results were obtained in 24 (92%) of 26 patients. Lumbar burst fractures with greenstick lamina fractures occur mostly in the L2-L4 area. In the surgical treatment, any reduction manoeuvre will close the fracture and crush the entrapped neural elements. Therefore, it may be better to explore the greenstick lamina fracture whether there is any neural entrapment or not, before any reduction manoeuvre is attempted.

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

“…Aydinli et al proposed that if there is any suspicion of a dural tear and/or nerve root entrapment, a posterior approach with an open book technique should be used to expose the dura safely before any reduction maneuvers are undergone [ 20 ]. Similar conclusion was found by Ozturk et al [ 31 ]. To the best of our knowledge, the present study is the first randomized controlled study to compare the Wiltse’s paraspinal approach with open book laminectomy for treatment of thoracolumbar burst fractures with greenstick lamina fractures.…”

Anterior corpectomy via the mini-open, extreme lateral, transpsoas approach combined with short-segment posterior fixation for single-level traumatic lumbar burst fractures: analysis of health-related quality of life outcomes and patient satisfaction

“…In this scenario, the posterior approach was performed before the anterior column decompression and cage placement to decompress the neural elements, evaluate for nerve root entrapment or dural tear, or both. 3,19 In patients without a greenstick fracture or a neurological deficit, posterior instrumentation by a percutaneous method (described below) was performed. Clinical data included patient age, sex, medical comorbidities, American Society of Anesthesiologists (ASA) classification, TLICS, associated injuries, perioperative neurological function, length of operation, incision length, intraoperative blood loss, need for chest tube placement and blood transfusions, postoperative complications, length of hospital stay, disposition, and need for revision surgery.…”

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].

“…No obstante, jerarquizamos dicha asociación por lo publicado en la bibliografía clásica y adjudicando la falta de significancia de dicha asociación quizás al bajo número de pacientes de nuestro estudio. [1][2][3][4] Al analizar la presencia de déficit neurológico en pacientes con fracturas toracolumbares, hallamos diferencias estadísticamente significativas en los pacientes con lesión dural frente a pacientes sin lesión dural. Estos resultados coinciden con lo publicado por Park y cols.…”

“…2 Según series publicadas, el porcentaje de lesiones durales asociadas a fracturas toracolumbares oscila entre el 18% y el 25%. 3,4 La importancia de las lesiones durales asociadas radica en las complicaciones que devienen por su cierre defectuoso o por no advertirlas, como seudomeningocele, fístula durocutánea, infecciones del sistema nervioso central (meningitis, aracnoiditis, absceso epidural), complicaciones con la cicatrización de la herida y cefalea persistente. [5][6][7][8][9][10] La sospecha clínica en las evaluaciones preoperatorias permite al cirujano espinal planificar la cirugía e incluir, en su estrategia, la reparación dural y así disponer de los elementos necesarios para su cierre (instrumental de microcirugía, lupas, microscopio, parches o adhesivos durales).…”