INTRODUCTION Traumatic injuries to the thoracolumbar spine represent a substantial proportion of high-energy trauma encountered globally. Lumbar vertebral fractures typically result from axial loading, flexion–distraction forces, or burst mechanisms, most commonly following falls from height or high-velocity road-traffic accidents [1]. These fractures may be accompanied by posterior ligamentous complex disruption, canal compromise, and varying degrees of neurological impairment. Among the more severe but relatively underreported complications is dural rupture. Traumatic dural tears have been documented in approximately 1–17% of thoracolumbar fractures [2]. Their occurrence is frequently associated with laminar fractures, retro pulsed osseous fragments, and shear forces generated during the traumatic event. In burst fractures, upward displacement of laminar fragments, fracture-dislocation, or direct impingement by unstable posterior elements may result in perforation of the dura mater [3]. The presence of a dural defect carries important clinical implications, as it predisposes patients to cerebrospinal fluid (CSF) leakage, pseudo meningocele formation, meningitis, persistent postural headaches, delayed wound healing, and, in severe cases, neurological deterioration due to herniation of neural elements through the defect [4,5]. These risks underscore the necessity of prompt intraoperative identification and meticulous repair. Posterior spinal fixation using pedicle screws and rods provides rigid stabilization, facilitates indirect decompression, and laminectomy allows direct visualization of the dural sac. Dural repair techniques commonly employ Prolene or nylon sutures, occasionally supplemented with fibrin sealants, with Prolene favored for its low tissue reactivity and long-term durability [6]. The present case report describes a young male with a traumatic lumbar fracture complicated by dural rupture, managed successfully with posterior fixation and Prolene dural repair, and highlights key clinical, radiological, and surgical considerations in such presentations. Case Presentation: A 22-year-old male was taken to emergency department after sustaining a fall from height. He stated severe lower back pain and an inability to move both lower limbs. On arrival, his condition was characterized as polytrauma, with further injuries including bilateral distal radius fracture and a left bimalleolar ankle fracture. Initial Assessment and Emergency Management The patient, at presentation, was hemodynamically stable. Early management followed trauma protocol and included intravenous administration of methylprednisolone, immobilization of the fractured limbs by splints, application of belt for a lumbar support and for spinal stabilization, and urinary catheterization due to impaired bladder function. Adequate analgesia and supportive care were provided. Neurological Examination Both lower extremities had significant areas of motor weakness noted on the Neurological assessment. In addition, there was a difference between the motor strength (in the right leg vs. the left leg): hip flexion 1/5 compared to 2/5, knee extension 2/5 and 3/5, ankle movements 2/5 in the right leg and 3/5 in the left leg, and EHL (extensor hallucis longus) 1/5 on the right leg and 4/5 on the left. Also, it should be noted that at the time of examination, the sensory tests for the lower extremities had been performed bilaterally and were positive for diminished to absent light touch with associated poor bowel and bladder control and sensation. Investigations Routine preoperative investigations included complete blood count, liver and renal function tests, electrolytes, coagulation profile, and a sickling test. Radiographs identified a lumbar vertebral fracture. MRI further demonstrated vertebral body disruption with canal compromise, suggestive of an associated traumatic dural tear. Surgical Procedure A posterior midline approach was utilized. The incision extended one level above and below the fracture. The posterior spinal components were revealed by subperiosteal dissection of the paraspinal muscles. During the procedure, spinous processes, laminae, ligamentum flavum, and pedicles were clearly visible. To accomplish posterior stability, pedicle rods and screws were inserted. To ensure a watertight closure, a dural rip was found and treated mostly using 4-0 Prolene sutures. The wound was closed using a typical layered technique after hemostasis was established. Postoperative Course The accurate placement of the pedicle screws and rods was confirmed by postoperative radiography. The patient's neurological condition did not worsen. With supporting aid, gradual mobilization was started. There were no signs of increasing bowel or bladder dysfunction, wound dehiscence, or cerebral fluid leaking following surgery. The patient's mobility during follow-up was in line with his neurological condition before to surgery. Intraoperative findings: Figure 1. Pre-operative MRI demonstrating lumbar vertebra fracture with canal compromise. Figure 2. Posterior exposure showing lamina, ligamentum flavum, and pedicles during surgery. Figure 3. Fixation With Screws and Rods Figure 4. Dural rupture visualized intraoperatively before repair. Figure 5. Dura repair using Prolene 4-0 suture. Figure 6. Postoperative X-ray showing proper placement of pedicle screws and rods. Bedside mobilisation under physiotherapy observation is the benefit after fixation and help to avoid long term complications or making the patient bedridden. The lack of postoperative deterioration supports the procedure's overall effectiveness and therapeutic benefit by indicating that the surgical intervention successfully stabilized the spine and avoided further neurological impairment.

Traumatic lumbar fractures often occur due to high-energy events like falls from heights, car accidents, or sports injuries. In these situations, neurological issues often happen because of spinal canal pressure from broken bone fragments or the formation of blood clots in the epidural space. Dural tears are a serious but often overlooked complication of these injuries. They usually happen when sharp laminar fractures penetrate the dura, when retropulsed bone fragments hit the thecal sac, or due to shearing forces created during flexion or distraction injuries like Chance fractures [2,3]. Although MRI can suggest a dural defect, many tears are clearly identified only during surgery. Timely recognition and repair of dural tears are crucial. If left untreated, defects can lead to ongoing cerebrospinal fluid (CSF) leakage, pseudo meningocele formation, meningitis, delayed wound healing, and intracranial hypotension with typical postural headaches [4]. In this case, primary dural repair using 4-0 Prolene achieved a watertight closure and prevented postoperative CSF-related issues. Prolene has several benefits for dural repair. It causes minimal tissue reactivity, offers high tensile strength, and provides long-lasting durability, making it a good choice for effectively closing traumatic dural defects [6]. Posterior fixation using pedicle screw and rod systems is important in the management of unstable lumbar fractures. The effectiveness of this technique includes providing immediate segmental stability, restoring spinal alignment, providing protection to the neuro-structures, and enabling the patient to be mobilized early following surgery [7]. The stable neurological status of the patient following surgery, as well as the absence of deterioration, indicates successful combination of stabilization and dural repair. While preoperative bowel and bladder dysfunction indicated significant neurodamage, stabilized fractures can prevent further damage and increase the likelihood of recovery of neurological function through rehabilitation.

Posterior fixation with meticulous dural repair using Prolene is a safe and effective approach in traumatic lumbar fractures complicated by dural tears. Early recognition and surgical management prevent CSF leakage, stabilize the spine, and preserve neurological function. This case supports current evidence favoring timely operative repair in similar injuries.

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