Risk factors for damage to the dura mater in thoracic and lumbar spine injury

Abstract

Objective. To clarify a significance of the risk factors for damage to the dura mater (DM) in fractures of the thoracic and lumbar spine.Material and Methods. The study is based on the analysis of examination data and surgical treatment results of 350 patients with spinal cord injury (SCI). Fractures of the thoracic spine were observed in 124 patients, and those of the lumbar spine in 226. The study included 167 operated patients who underwent posterior decompression at the fracture level using laminectomy and transpedicular fixation of the injured spinal motion segment. There were two groups of patients: study group included 55 patients with DM rupture and control one – 112 patients without damage to the DM.Results. Damage to the DM was found in 32.9 % of patients, the rupture was localized on the posterior surface of the dural sac. In patients with rupture of the dura mater, ASIA type A and B neurological disorders were significantly more common (p = 0.00065). The DM damage occurs significantly more often in patients with type C fracture according to the AOSpine classification, with multilevel spinal injuries and combined SCI (Injury Severity Score more than 27.58 ± 9.46 points). The most significant risk factors for the development of DM ruptures are narrowing of the spinal canal at the fracture level by more than 50 %, a fracture of the vertebral arch, an increase in the relative interpedicular distance of more than 20 %, and diastasis between the fragments of the arches by more than 2.5 mm.Conclusion. The damage to the dura mater is a common complication of vertebral fracture. The prediction of dura mater rupture will allow optimizing surgical approach and improving the treatment outcome.