Abstract
IntroductionThe appropriate and optimal treatment for thoracic and lumbar (TL) burst fractures remains a topic of debate. Characterization of vertical laminar fractures (coronal cross-sectional imaging) is presented in this study to determine the severity and treatment options in TL burst fractures.MethodsA retrospective evaluation of 341 consecutive patients with TL burst fractures was divided into Group I (whole), Group II (partial), and Group III (intact) based on the vertical laminar fracture morphology from coronal images on computed tomography (CT) scans. The presence of preoperative neurological status was reviewed, and several radiological parameters were measured. In addition, the incidence of dural tears was calculated in patients that underwent a decompression with posterior approach.ResultsIn total, 270 lumbar and 71 thoracic burst fractures were analyzed. Compared with the intact group, the two other groups had significantly shorter central canal distance, wider interpedicular distance, and smaller spinal canal area, in particular, Group III. The incidences of preoperative neurological deficits in Groups I to III were 63.0, 22.2, and 6.3%, respectively. The incidences of dural tears in Groups I to III were 25.6, 6.3, and 0%, respectively.ConclusionThe morphology of vertical laminar fractures observed across the coronal plane was important. Patients with “whole”, “partial” and “intact” laminar fractures indicated different severity of TL burst fractures. Due to the high probability of dural tears, decompression is recommended as a primary intervention for patients with “whole” laminar fractures. However, for patients without vertical laminar fractures, minimally invasive technique might be a better choice to avoid approach-related complications.
Highlights
The appropriate and optimal treatment for thoracic and lumbar (TL) burst fractures remains a topic of debate
This study aims to determine the characteristic fracture morphology, preoperative neurological status, and radiological findings of patients with vertical laminar fractures
The laminar fracture was a reliable factor to assess the severity of spinal lesions [1, 3], which usually occurred in TL burst fractures [2]
Summary
The appropriate and optimal treatment for thoracic and lumbar (TL) burst fractures remains a topic of debate. Characterization of vertical laminar fractures (coronal cross-sectional imaging) is presented in this study to determine the severity and treatment options in TL burst fractures. Thoracic and lumbar (TL) burst fractures have been reported for several decades [1]. Studies into the morphology [3,4,5, 7], the incidence of dural tears, nerve root entrapment, and spinal cord compression on axial cross sectional anatomy were quite a lot [4, 5, 7]. The importance to the coronal morphology of laminar fractures appears to be underestimated for its indispensability to assess stability across the fracture segment
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