The effect of laminae lesion on thoraco-lumbar fracture reduction

Skiak, E.; Karakaşlı, Ahmet; Harb, Afif; Satoğlu, İsmail Safa; Başçı, Onur; Havıtçıoğlu, Hasan

doi:10.1016/j.otsr.2015.02.011

Cited by 16 publications

(23 citation statements)

References 27 publications

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“…Several studies have documented herniation of the neural elements between the fractured lamina edges, which can cause further neurological compromise [ 17 18 ]. Skiak et al [ 8 ] showed a strong association between the occurrence of a complete lamina fracture and a dural tear. In tears of dura, the likelihood of neural entrapment have been demonstrated at 33% in complete lamina fractures and 15% in incomplete lamina fractures.…”

Section: Discussionmentioning

confidence: 99%

“…In tears of dura, the likelihood of neural entrapment have been demonstrated at 33% in complete lamina fractures and 15% in incomplete lamina fractures. Surgeons are advised to be particularly careful with patients with complete lamina fractures [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Lamina injury is considered a severity marker in burst fractures [ 23 ]. Several authors recommend a laminectomy for lamina injuries in burst fractures to avoid possible entrapment of the neural element by crushing during reduction maneuvers [ 8 10 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…Many reports have documented neural element entrapment between fractured lamina edges [ 5 6 ]. A dural tear and neural entrapment in lumbar burst fractures have been documented in different studies to range from 19% to 47% [ 7 8 ]. One of the goals of surgical treatment of lumbar burst fracture is the restoration of the anatomy of the spinal column, including the spinal canal.…”

Section: Introductionmentioning

confidence: 99%

“…Any reduction maneuver of a burst fracture accompanied with a lamina fracture will close the fractured lamina edges and crush the entrapped neural elements. Therefore, when a lamina fracture is present, it is critical to evaluate whether there is any neural entrapment to prevent further neurological impairment [ 8 9 10 ]. To date, the information on reduction maneuvers have not relied on solid biomechanical trials and have been mostly dependent on clinical experience.…”

Section: Introductionmentioning

confidence: 99%

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Behavior of Injured Lamina in Lumbar Burst Fractures during Reduction Maneuvers: A Biomechanical Study

Acar¹

2017

Asian Spine J

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Study DesignAn experimental biomechanical study.PurposeThis study aims to investigate the behavior of a lamina injury in lumbar burst fractures during reduction maneuvers.Overview of LiteratureLumbar burst fractures are frequently accompanied by a lamina fracture. Many researchers concluded that any reduction maneuver will close the fractured lamina edges and possibly crush the entrapped neural elements. This conclusion did not rely on solid biomechanical trials and was based primarily on clinical experience.MethodsEighteen fresh-frozen lamb spines were randomly divided into three groups. Using the preinjury and the dropped-mass technique, a burst fracture model was developed. A central laminectomy of 5 mm of the L3 lumbar spine was created to mimic a complete type of lamina fracture. To measure the movement of the fractured laminar edges, two holes were drilled on both sides of the upper and lower regions of the lamina to allow for optic marker placement. A single specific spine movement was applied to each group: traction, flexion, and extension. Gap changes were measured by camera extensometers.ResultsAfter traction, the average values of the upper and lower aspects of the lamina interval showed narrowing of 1.65±0.82 mm and 1.97±1.14 mm, respectively. No statistical significance was detected between the two aspects. The upper and lower regions of the lamina gap behaved differently during extension. At 10°, 20°, and 30°, the upper part of the lamina interval was widened by an average of 0.016±0.024, 0.29±0.32, and 1.73±1.45 mm, respectively, whereas the lower part was narrowed by an average of 0.023±0.012, 0.47±0.038, and 1.94±1.46 mm, respectively.ConclusionsNeural element crushing may take place, particularly at the lower aspect of the fractured lamina gap during extension and throughout the whole lamina gap during traction. The lamina gap widens during flexion. Reduction maneuvers should be attempted after exploring the fractured lamina to prevent further neurological compromise.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%