Dural tears from traumatic spinal fractures: an illustrative case and systematic review of its incidence, diagnosis, risk factors, and management.

Background: There has not been universal consensus on the management of traumatic dural tears. This case report and systematic review highlighted the incidence, risk factors, diagnostic clues, surgical management and prognosis of dural rupture in the context of traumatic spinal fractures. Methods: A total of 3 databases were included in the literature search: PubMed, Cochrane and Scopus. Search terms included "(dural tear OR dural rupture)" AND "(vertebral fracture OR burst fracture)". Primary outcomes included (I) the incidence of dural tears and etiologies; (II) radiological risk factors; (III) time to surgery and preoperative neurology; (IV) dural repair method; (V) surgical stabilisation; (VI) complications; and (VII) postoperative neurological outcomes. Results: A case of a 57-year-old male with accidental fall from height was presented. Despite being neurologically intact on admission, he developed acute cauda equina syndrome with imaging revealing a three-column L3 fracture with cauda equina compression. He subsequently underwent urgent first-stage posterior decompression and instrumented L2-L4 spinal fusion, during which a traumatic dural rupture caused by L3 lamina fracture was identified and primarily repaired. A second-stage anterior L3 corpectomy and anterior column reconstruction with fusion was performed. For the review, twenty-seven articles, including 8 case reports, were included. Incidence of dural tears after traumatic spinal fractures ranged from 2.9% to 94.7%. Interpedicular distance, presence of whole laminar fractures, central canal diameter and posterior element fractures were radiological indicators for dural lacerations. Most patients presented with incomplete neurological deficit and surgical intervention for most cases involved posterior stabilisation of spine with primary suture repair of the dural laceration. Complications included cerebrospinal fluid (CSF) leakage, pseudomeningoceles and nerve entrapment. Postoperative course was generally satisfactory with up to 61% of patients making complete recovery and returning to function. Conclusions: Dural tears were not uncommon after traumatic spinal injuries, especially in lumbosacral impaction or burst fractures. Radiographic predictors for dural lacerations included interpedicular distance and canal diameter. Current standard of dural repair involves primary suture, while adjunctive techniques (grafts and patches) were only recommended when primary repair was not feasible. The need for immediate surgical treatment is emphasized in patients with incomplete neurological deficits given their recovery potential.