Dural lacerations and thoracolumbar fractures.

In the pre-CT era, Miller et al. reported the presence of dural lacerations (DL) and herniations of the cauda equina in a group of patients with thoracolumbar fractures that involved separation of the pedicles, as detailed on plain radiographs. Recently, these injuries have been well characterized on CT scan. We retrospectively reviewed our series of thoracolumbar burst fractures to assess the predictive value of CT for the presence of a DL, and the clinical significance of this finding. Twenty-five patients with 27 levels of injury were assessed. Dural lacerations were noted in eight (32%) of the cases. These were significantly associated with posterior element fractures noted on axial CT, and with motor neurologic deficits. There was no correlation between the presence of a DL and the degree of spinal canal compromise. Dural lacerations occur relatively frequently in patients with thoracolumbar fractures that require operative management. Their presence should be of particular concern in those cases with a motor deficit on presentation and a posterior element fracture on axial CT scan.