Anterior, thoracoscopic-assisted reduction and stabilization of a thoracic burst fracture (T8) in a pregnant woman

Abstract

Injuries of the spine in pregnant women are rare. Unstable fractures, incomplete neurological deficits and failed conservative treatment are indications for operative stabilization. So far, only posterior stabilization techniques performed during pregnancy have been published in case reports. This Grand Round case presentation describes a 24-year-old woman in the 19th week of gestation who was involved in a motorcycle accident as a pillion rider.Radiological examination revealed a complete burst fracture (type AO A3.3) of T8 with a slight, yet clinical unapparent narrowing of the spinal canal and a stable T5 fracture (type AO A1.2). Despite analgesia with morphine, conservative treatment failed and it was not possible to mobilize the patient. Hence, an anterior thoracoscopicassisted reduction and stabilization in left lateral position with single lung ventilation was performed as the therapy of choice. Intraoperatively, the body of T8 was removed and plate was used to stabilize and reduce the fracture. Finally, a tricortical iliac bone graft was implanted into the bony defect. Intraoperative fluoroscopy was merely used to verify the positioning of the implants. Postoperative examination of the foetus revealed normal findings. The patient was discharged with paracetamol as residual pain medication. The degree of kyphosis of the T8 fracture was successfully reduced from 20°to 13°(segmental standard value 12°). Further clinical and radiological course of the patient was uneventful. If suitable implants are available and good bone structure exists, solely anterior thoracoscopic-assisted reduction and stabilization of an unstable thoracic burst fracture can be performed safely. In the present case, it was possible to avoid intraoperative prone positioning of the pregnant patient as well as reaching a minimum of radiation exposure.

Establishing the Injury Severity of Thoracolumbar Trauma

“…16 Comparatively in North America, Bailey et al 17 performed a multicentered randomized trial and found that thoracolumbar burst fractures could be treated even without a brace. Furthermore, even when comparing the most controversial fracture subtypes, burst fractures with a single endplate involved (A3) and burst fractures with both endplates involved (A4), a statistically signifi cant difference in severity score was identifi ed implying the meaningfulness of this distinction.…”

Obstetric Outcomes of Women Who Sustained Traumatic Spinal Injury during Pregnancy: A Systematic Review

“…Finally, 16 publications reporting on 26 cases were included in the systematic review. Eleven (68.8%) of the included studies had poor methodological quality, while the remaining 5 (31.2%) had moderate methodological quality [2,6,7,9,10,12,[16][17][18][19][20][21][22][23][24][25] (Table 1).…”

Traumatic Fractures of the Thoracic Spine

“…The advantages of the exclusively anterior approach lie in the protection of the posterior muscles, the direct decompression of an-terior neural impingement structures and biomechanically effective stabilisation. In rare cases, it may also be an alternative to the posterior procedure for those patients who cannot tolerate the prone position [51]. Anterior stabilisations are usually only indicated as far up as T5/6.…”

“…Anterior procedures play a secondary role in the ThSp owing to the lower transmission of load and the stabilising effect of the ribcage in comparison with the thoracolumbar junction and LSp regions, although they may be indicated in cases of residual spinal stenosis and burst fractures [51]. Exclusively anterior procedures and one-stage posteroanterior approaches only play a minor role in the acute situation.…”