The Correlation Between Vertical Laminar Fractures and the Severity of Associated Burst Fractures

Patients with laminar fractures have a higher chance of experiencing severe trauma and neurologic deficit. In previous studies, laminar fractures were divided into different types based on the axial plane of computed tomographic scans. No report described the morphology of vertical laminar fractures in the coronal plane. Furthermore, the correlation between a specific type of laminar fracture and the extent of severity of thoracolumbar (TL) burst fractures has rarely been mentioned.

A retrospective evaluation of 341 patients with TL burst fractures with or without laminar fractures were divided into 6 groups based on the morphology observed across reconstructed coronal and axial computed tomographic planes. The Thoracolumbar Injury Classification and Severity Score (TLICS), Load Sharing Classification (LSC), and American Spinal Injury Association (ASIA) impairment scale were evaluated for each patient. Intergroup comparisons were also performed for all metrics.

The TLICS, LSC, and ASIA impairment scale were determined for each laminar fracture group. Statistical differences were found in most intergroup comparisons across all metrics. Significantly higher injury scores were observed in the groups with a more severe coronal and axial laminar fracture, and the injury severity in the coronal scan played a more decisive role.

The morphology of vertical laminar fractures as observed across multiple image planes was more complex and accurate than an analysis based solely on the axial plane. Different morphologies indicated differences in the severity of associated TL burst fractures. The laminar fracture in the coronal plane was associated with the severity of spinal injury.