STUDY DESIGN: A retrospective case study. PURPOSE: To retrospectively review all incidental dural tears (DTs) that occurred at a single institution, classify them anatomically and evaluate the clinical significance of each subgroup. OVERVIEW OF LITERATURE: Dural tears are considered the most commonly encountered complication during lumbar spine surgery. In contrast to the high frequency of DTs, reports on the characteristic location and mechanism are sparse. METHODS: We retrospectively retrieved all cases of degenerative lumbar spine surgery performed over a 9-year period and classified all identified DTs according to two independent planes. The coronal plane was divided into lower, middle and upper surgical fields, and the sagittal plane into posterior, lateral and ventral occurring tears. Demographic and clinical variables were retrieved and analyzed to search for significant associations. RESULTS: From 2003 to 2011, 1,235 cases of degenerative lumbar spine conditions were treated surgically at our institution. In 84 operations (6.8%), an incidental DT was either identified intraoperatively or suspected retrospectively. The most commonly involved location was the lower surgical field (n=39, 46.4%; p=0.002), followed equally by the middle and upper fields (n=16, 19%). In the sagittal plane, the most commonly involved locations were those in close proximity to the nerve root (n=35, 41.6%), followed by the dorsal aspect of the dural sac (n=24, 28.6%). None of the variables recorded was found to be associated with a particular location. CONCLUSIONS: In our series, incidental DTs were found to occur most commonly in the lower surgical field. We hypothesize that local anatomic feature, such as the lordotic and broadening lumbar dura, may play a role in the observed DT tendency to occur in the lower surgical field. In light of the high frequency and potentially substantial resulting morbidity of incidental DTs, a better characterization of its location and mechanism may optimize both prevention and management.
Humans ; Lumbosacral Region ; Retrospective Studies* ; Spine*

Methods: We retrospectively identified all patients treated for thoracolumbar fractures in Assaf Harofe Medical Center between January 2008 and July 2013. Pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) were measured for the pelvic parameters. For each patient, we classified the fracture according to the AOSpine Thoracolumbar Spine Injury Classification System. Height loss was measured initially and at a minimum of 3-month follow-up. The difference between initial and final height loss was documented as height loss difference. Results: The study included 124 patients comprised 86 women and 38 men. The mean patient age was 69±9.6 years. The mean length of follow-up was 14±15 months. No significant effect of the PI, PT, and SS angles on the vertebral fracture level (p >0.05) was found. Similarly, no significant relationship between the PI, PT, and SS angle and the fracture type according to the AO classification (p >0.05) was found. There was no correlation between PI, PT, and SS angles and initial height loss, final height loss and height loss difference (p> 0.05) Conclusions The spinopelvic configuration represented by the PI, PT, and SS angle does not influence progressive collapse following acute osteoporotic compression spine fractures.