Surgical Approach of Thoracolumbar or Lumbar Bursting Fracture with Associated Laminar Fracture

ABSTRACT

In case of thoracolumbar or lumbar bursting fractures with associated laminar fracture, there are the possibilities of posterior dural lacerations or neural entrapment caused by impaction of the dural sac into the gap of the fractured lamina. We treated thirty six patients of these fractures with anterior or posterior approach during last 10 years. The posterior approach had less delayed kyphosis and postoperative cerebrospinal fluid leakage than the anterior approach. Posterior dural laceration was noted during operation in sixteen cases out of a total of thirty six patients. The statistical analysis revealed significant associations of the dural laceration with preoperative neurological deficits, high grade spinal canal compromise, and comminuted laminar fracture. These patients should undergo posterior exploration of the spinal canal, extraction of neural elements, and repair of the lacerated dura before any spinal reconstruction maneuver.