Thecal sac injury secondary to burst fractures of the thoracolumbar and lumbar spine, and its association with the AOSpine Classification System variables.
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Published:
Aug 5, 2019
Keywords:
Thoracolumbar fractures, thecal sac injury, preoperative planning
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Abstract
Introduction: 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 suspected when 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 (fracture type C according to the AOSpine Classification System).
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Ricciardi, G. A., Garfinkel, I. G., Carrioli, G. G., & Ricciardi, D. O. (2019). Thecal sac injury secondary to burst fractures of the thoracolumbar and lumbar spine, and its association with the AOSpine Classification System variables. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 84(3), 216-223. https://doi.org/10.15417/issn.1852-7434.2019.84.3.926
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Clinical Research
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References
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15. Lee IS, Kim HJ, Lee JS, Kim SJ, Jeong YJ, Kim DK, et al. Dural tears in spinal burst fractures: predictable MR imaging findings. Am J Neuroradiol 2009;30(1):142-6. https://doi.org/10.3174/ajnr.A1273
16. Yoshiiwa T, Miyazaki M, Kodera R, Kawano M, Tsumura H. Predictable imaging signs of cauda equina entrapment in thoracolumbar and lumbar burst fractures with greenstick lamina fractures. Asian Spine J 2014;8(3):339-45.
https://doi.org/10.4184/asj.2014.8.3.339
17. Aydnl U, Karaeminogullar O, Tiskaya K, Öztürk Ç. Dural tears in lumbar burst fractures with greenstick lamina fractures. Spine 2001;26(18):E410-E415. PMID: 11547211
18. Pickett J, Blumenkopf B. Dural lacerations and thoracolumbar fractures. J Spinal Disord 1989;2:99-103. PMID: 2520069
19. Vaccaro AR, Oner C, Kepler CK, Dvorak M, Schnake K, Bellabarba C, et al. AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine 2013;38(23):2028-37.
https://doi.org/10.1097/BRS.0b013e3182a8a381
20. Luszczyk MJ, Blaisdell GY, Wiater BP, Bellabarba C, Chapman JR, Agel JA, et al. Traumatic dural tears: what do we know and are they a problem? Spine J 2014;14(1):49-56. https://doi.org/10.1016/j.spinee.2013.03.049
21. Pau A, Silvestro C, Carta F. Can lacerations of the thoraco-lumbar dura be predicted on the basis of radiological patterns of the spinal fractures? Acta Neurochirurgica 1994;129(3-4):186-7. PMID: 7847161
22. Kahamba JF, Rath SA, Antoniadis G, Schneider O, Neff U, Richter HP. Laminar and arch fractures with dural tear and nerve root entrapment in patients operated upon for thoracic and lumbar spine injuries. Acta Neurochirurgica 1998;140(2):114-9. PMID: 10398989
2. Denis F, Burkus JK. Diagnosis and treatment of cauda equina entrapment in the vertical lamina fracture of lumbar burst fractures. Spine (Phila Pa 1976) 1991;16(8 Suppl):S433-9. PMID: 1785101
3. Keenen TL, Antony J, Benson DR. Dural tears associated with lumbar burst fractures. J Orthop Trauma 1990;4:243-5. PMID: 2231119
4. Ozturk C, Ersozlu S, Aydinli U. Importance of greenstick lamina fractures in low lumbar burst fractures. Int Orthop 2006;30:295-8. https://doi.org/10.1007/s00264-005-0052-0
5. Borgesen S, Vang P. Extradural pseudocysts. A cause of pain after lumbar-disc operation. Acta Orthop Scand 1973;44:12-20. PMID: 4702604
6. Nash C Jr, Kaufman B, Frankel V. Postsurgical meningeal pseudocysts of the lumbar spine. Clin Orthop Relat Res 1971;75:167-78. https://doi.org/10.1097/00003086-197103000-00023
7. O’Connor D, Maskery N, Griffiths W. Pseudomeningocele nerve root entrapment after lumbar discectomy. Spine 1998;23:1501-2. PMID: 9670405
8. Mayfield F. Complications of laminectomy. Clin Neurosurg 1976;23:435-9. PMID: 975694
9. Verner E, Musher D. Spinal epidural abscess. Med Clin North Am 1985;69:375-84. PMID: 3990440
10. Sciubba D, Kretzer R, Wang P. Acute intracranial subdural hematoma following a lumbar CSF leak caused by spine surgery. Spine (Phila Pa 1976) 2005;30:E730-2. PMID: 16371890
11. Bosacco SJ, Gardner MJ, Guille JT. Evaluation and treatment of dural tears in lumbar spine surgery: a review. Clin
Orthop Relat Res 2001;389:238-47. https://doi.org/10.1097/00003086-200108000-00033
12. Leo JS, Bergeron RT, Kricheff II, Benjamin VB. Metrizamide myelography for cervical spinal cord injuries. Radiology 1978;129(3):707-11. https://doi.org/10.1148/129.3.707
13. Post MJ, Green BA. The use of computed tomography in spinal trauma. Radiol Clin North Am 1983;21:327-75. PMID: 6867315
14. Park JK, Park JW, Cho DC, Sung JK. Predictable factors for dural tears in lumbar burst fractures with vertical laminar fractures. J Korean Neurosurg Soc 2011;50(1):11-16. https://doi.org/10.3340/jkns.2011.50.1.11
15. Lee IS, Kim HJ, Lee JS, Kim SJ, Jeong YJ, Kim DK, et al. Dural tears in spinal burst fractures: predictable MR imaging findings. Am J Neuroradiol 2009;30(1):142-6. https://doi.org/10.3174/ajnr.A1273
16. Yoshiiwa T, Miyazaki M, Kodera R, Kawano M, Tsumura H. Predictable imaging signs of cauda equina entrapment in thoracolumbar and lumbar burst fractures with greenstick lamina fractures. Asian Spine J 2014;8(3):339-45.
https://doi.org/10.4184/asj.2014.8.3.339
17. Aydnl U, Karaeminogullar O, Tiskaya K, Öztürk Ç. Dural tears in lumbar burst fractures with greenstick lamina fractures. Spine 2001;26(18):E410-E415. PMID: 11547211
18. Pickett J, Blumenkopf B. Dural lacerations and thoracolumbar fractures. J Spinal Disord 1989;2:99-103. PMID: 2520069
19. Vaccaro AR, Oner C, Kepler CK, Dvorak M, Schnake K, Bellabarba C, et al. AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine 2013;38(23):2028-37.
https://doi.org/10.1097/BRS.0b013e3182a8a381
20. Luszczyk MJ, Blaisdell GY, Wiater BP, Bellabarba C, Chapman JR, Agel JA, et al. Traumatic dural tears: what do we know and are they a problem? Spine J 2014;14(1):49-56. https://doi.org/10.1016/j.spinee.2013.03.049
21. Pau A, Silvestro C, Carta F. Can lacerations of the thoraco-lumbar dura be predicted on the basis of radiological patterns of the spinal fractures? Acta Neurochirurgica 1994;129(3-4):186-7. PMID: 7847161
22. Kahamba JF, Rath SA, Antoniadis G, Schneider O, Neff U, Richter HP. Laminar and arch fractures with dural tear and nerve root entrapment in patients operated upon for thoracic and lumbar spine injuries. Acta Neurochirurgica 1998;140(2):114-9. PMID: 10398989