LAMINAR AND ARCH FRACTURES WITH DURAL TEAR AND NERVE ROOT ENTRAPMENT IN PATIENTS OPERATED UPON FOR THORACIC AND LUMBAR SPINE INJURIES

Objective: To determine the neurological outcome in patients with lami nar fractures associated with dural tears and nerve root entrapment, o perated upon for thoracic and lumbar spine injuries. Patient populatio n: Out of 103 patients operated upon consecutively for thoracic and lu mbar spine injuries during the period 1990 to 1994 inclusive, 24 (23.3 %) patients had laminar fractures out of whom 3 (2.9%) had an associat ed dural tear and an other 17 (16.5% or 70.88 of the total patients wi th laminar fractures) had an associated dural tear and nerve root entr apment. Results: Twelve (70.5%) patients had injury at the thoraculumb ar junction, 13 (76.5%) had Magerl's type A3 or above, 10 (58.8%) had a kyphotic angle deformity greater than 5 degrees. Seven (41.1%) had t heir 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 (Franke l E) worsened to Frankel D. However, one patient among the 3 with init ial Frankel A improved to Frankel C while both patients with initial F rankel C usefully improved to final Frankel grades D and E respectivel y. Two of the four patients with initial Frankel D improved to Frankel E. the other 2 remaining unchanged. All in all five patients neurolog ical status improved, it worsened and 8 remained unchanged after neuro surgical treatment. Conculsions: 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, speci al operative precautions lead to significant improvement in some of th em although a majority remain unchanged or even worsened.