Predictive Indicators of Traumatic Dural Tear in Dorsal and Lumbar Spine Fractures and an Integrated Clinical–Imaging Risk Score: A Retrospective Study

Abstract

Background: Traumatic dural tears (TDTs) are clinically significant complications associated with thoracolumbar spine fractures and may result in cerebrospinal fluid leakage, pseudo meningocele formation, infection, and delayed recovery. Early recognition of patients at risk for TDT can assist in surgical planning, reduce complications, and improve postoperative outcomes.  Objective: To identify clinical and radiological predictors of traumatic dural tears in patients with thoracolumbar spine fractures and to develop an integrated clinical–imaging risk score for preoperative prediction.  Methods: A retrospective cohort study was conducted at a tertiary care centre between August 2022 and May 2025. Patients who underwent surgical management for thoracolumbar fractures and had complete preoperative imaging and intraoperative documentation were included. Demographic variables, mechanism of injury, AO Spine classification, neurological status according to the ASIA scale, and radiological parameters were analysed. Radiological variables included canal compromise, laminar fracture, pedicle fracture, retro pulsed fragments, CSF signal discontinuity, loss of epidural fat plane, and dural spiking sign. Intraoperative confirmation of dural tear served as the reference standard.