Laminar and Arch Fractures with Dural Tear and Nerve Root Entrapment in Patients Operated upon for Thoracic and Lumbar Spine Injuries |
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Authors: | JF Kahamba SA Rath G Antoniadis O Schneider U Neff HP Richter |
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Institution: | (1) Department of Neurosurgery, University of Ulm, Guenzburg, Federal Republic of Germany, DE |
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Abstract: | Summary
Objective: To determine the neurological outcome in patients with laminar fractures associated with dural tears and nerve root entrapment,
operated upon for thoracic and lumbar spine injuries.
Patient population: Out of 103 patients operated upon consecutively for thoracic and lumbar spine injuries during the period 1990 to 1994 inclusive,
24 (23.3%) patients had laminar fractures out of whom 3 (2.9%) had an associated dural tear and an other 17 (16.5% or 70.8%
of the total patients with laminar fractures) had an associated dural tear and nerve root entrapment.
Results: Twelve (70.5%) patients had injury at the thoraculumbar junction, 13 (76.5%) had Magerl's type A3 or above, 10 (58.8) had
a kyphotic angle deformity greater than 5°. Seven (41.1%) had their spinal canal's sagittal diameter reduced by at least 50%
and two had dislocations. Nine (52.9%) had initial neurological deficits.
Four (50%) out of 8 patients with no initial neurological deficits (Frankel E) worsened to Frankel D. However, one patient
among the 3 with initial Frankel A improved to Frankel C while both patients with initial Frankel C usefully improved to final
Frankel grades D and E respectively. Two of the four patients with initial Frankel D improved to Frankel E, the other 2 remaining
unchanged. All in all five patients' neurological status improved, 4 worsened and 8 remained unchanged after neurosurgical
treatment.
Conclusions: Vertical laminar fractures with dural tears and nerve root entrapment represent a special group of thoracic and lumbar spine
injuries that carry a poor prognosis. However, special operative precautions lead to significant improvement in some of them
although a majority remain unchanged or even worsened. |
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Keywords: | : Spine fractures lamina fracture dural tear root entrapment neurological deficit |
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