Traumatic Durotomy with Entrapment of Nerve Roots in a Lumbar Burst Fracture Diagnosed Intraoperatively: A Case
Dileepan Chakrawarthi1, Harish K Nagappa1, S Sivamurugan1
1Department of Orthopedic Surgery, Soundarapandian Bone and Joint Hospital and Research Institute, Chennai, Tamil Nadu, India.
Background:
Traumatic dural tears associated with thoracolumbar burst fractures are uncommon and are rarely complicated by entrapment of neural elements. Pre-operative diagnosis is challenging, and such injuries are often identified only during surgery. Unrecognized dural tears and entrapped nerve roots may result in further neurological injury during operative manipulation.
Case Report:
A 34-year-old male presented with an L3 burst fracture following a fall from height and had an incomplete neurological deficit below the L2 level. Radiological evaluation revealed an unstable lumbar burst fracture with laminar involvement. During posterior decompression and stabilization, a large traumatic dural tear with entrapment of nerve rootlets within the laminar fracture was identified intraoperatively. Careful release of the entrapped neural elements and primary dural repair were performed, followed by posterior instrumentation. The patient showed progressive neurological recovery with no cerebrospinal fluid-related complications.
Conclusion:
Traumatic durotomy with nerve root entrapment can occur in high-energy lumbar burst fractures, particularly in the presence of laminar fractures, and may be missed on pre-operative imaging. A high index of suspicion and meticulous intraoperative evaluation are essential to prevent iatrogenic neurological injury and to achieve favorable outcomes.
