Dural penetration caused by a vertebral bone fragment in a lumbar burst fracture: a case report

This case report describes an unusual case of lumbar burst fracture in which a bone fragment from the vertebral body penetrated into the dorsal dura through the ventral dura mater, requiring bone fragment extraction via an intradural approach.

A 23-year-old male involved in a motor vehicle accident was admitted to our hospital complaining of right leg paresis and bladder-bowel disorder. Computed tomography (CT) revealed an L5 burst fracture of type B by the Denis classification scheme, with a bone fragment from the vertebral body that had perforated the ventral aspect of the dura mater and penetrated dorsally. We abandoned attempts to extract the bone fragment via an epidural approach and instead resected the fragment via an intradural approach with a dorsal dural incision. We corrected L4/5 kyphosis as possible and performed L4/5 posterolateral fusion. The patient's leg paralysis and bladder-bowel disorder were relieved, and he was discharged 2 months after the surgery with the ability to walk without crutches.

When bone fragments penetrate the dura mater, their extraction must be performed with particular care. For cases in which the dura mater cannot be pulled apart, the removal of bone fragments using an intradural approach is appropriate.