Characteristics and treatments of spinal fractures associated with dural tears

Abstract

Objective To investigate the characteristics and treatment effects in patients with spinal fractures associated with dural tears. Methods A retrospective analysis was made on 185 patients with spinal fractures presenting to hospital from February 2013 to February 2015. There were 103 males and 82 females, aged 17-73 years (mean, 58 years). Causes of injury were high falls in 72 patients , traffic collisions in 58, hitting by heavy objects in 41, ground-level falls in 12, and collision events in two. Cervical spine fractures were seen in 65 patients, thoracic vertebra fractures in 51, and lumbosacral vertebral fractures 69. Neurologic deficit was assessed using the American Spinal Injury Association (ASIA) score, including grade A in 24 patients, grade B in 22, grade C in 26, grade D in 37 and grade E in 76. Eighty patients were managed by simply anterior surgery, 97 by posterior surgery, and eight by anterior-posterior surgery. Twenty-one patients were found with dural tears (group A) and 164 patients without dural tears (group B). Incidence of dural tears in cervical, thoracic and lumbosacral vertebral fractures were recorded and compared. Preoperative neurologic deficit, laminar fracture and spinal canal encroachment rate were compared between groups. Neurological function and complications associated with dural repair were detected. Results In group A, ten patients were rated ASIA grade A, five grade B, three grade C, one grade D and two grade E. In group B, 14 patients were rated ASIA grade A, 17 grade B, 23 grade C, 36 grade D and 74 grade E. Group A accounted for 11%(7/65) of cervical, 10%(5/51) of thoracic, and 13%(9/69)of lumbosacral spine fractures (P>0.05). Nineteen patients (91%) in group A were complicated with neurological deficit, compared to ninety patients (54.9%) in group B (P<0.01). Eighteen patients (86%) in group A had laminar fractures, compared to fifteen patients (9.1%) in group B (P<0.01). In group A, rate of spinal canal encroachment was (62.3±12.1)% and 17 patients (81%) showed spinal canal encroachment of greater than 50%. While in group B, rate of spinal canal encroachment was (36.2±15.6)% and 25 patients (15.2%) showed spinal canal encroachment of greater than 50% (P<0.01). For dural tears in group A, 11 patients were treated by direct suturing, four by thoracolumbar fascia repair, three by artificial dural coverage and three by fibrin glue sealing. In group A, 19 patients were followed up and one of them presented persistent cerebral spinal fluid leak that necessitated an irrigation and debridement to cure. ASIA score was improved from grade A to B in two patients, grade B to C in one, grade C to D in one and grade D to E in one at the final follow-up. Conclusions Majority patients with spinal fractures associated with dural tears exist severe neurologic deficit, spinal canal encroachment and laminar fractures. Incidence of dural tear in cervical, thoracic and lumbosacral vertebral fractures is similar. Incidence of complications related to dural tear repair is low, but the neurological function recovery is poor after operation. Key words: Spinal fractures; Dura mater; Spinal cord injuries; Complications