Dural Tears Associated with Burst Fractures of Lumbar Vertebrae: A Series of Three Cases

Abstract

Burst fractures of dorsolumbar vertebrae are a common occurrence. There is presence of dural tear in approximately 7.7% of cases, but its diagnosis is commonly missed because of lack of preoperative suspicion. Its preoperative diagnosis is an important adjunct in making a rationale decision for choosing surgical approaches and care during surgery. Magnetic resonance imaging (MRI) is not always helpful in its detection and has its own drawbacks. Out of a total of 27 patients operated for burst fractures of dorsolumbar vertebrae, 3 had a dural tear. Patients who were suspected to have dural tears were taken up for surgical intervention either only posteriorly or along with anterior approach. All three patients had neurologic deficits, widened interpedicular distance, laminar fracture of Gd 1 or more with canal compromise greater than 50%, and wedging with an acute angle. Presence of dural tear with wedging of roots was confirmed intraoperatively. Active effort should be made to detect presence of dural tears if patients of dorsolumbar burst fractures have neurologic deficit, laminar fracture is present, interpedicular distance is widened, and there is severe canal encroachment with an acute angle of the wedge.