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

[摘要] OpenimageinnewwindowInjuriesofthespineinpregnantwomenarerare.Unstablefractures,incompleteneurologicaldeficitsandfailedconservativetreatmentareindicationsforoperativestabilization.Sofar,onlyposteriorstabilizationtechniquesperformedduringpregnancyhavebeenpublishedincasereports.ThisGrandRoundcasepresentationdescribesa24-year-oldwomaninthe19thweekofgestationwhowasinvolvedinamotorcycleaccidentasapillionrider.Radiologicalexaminationrevealedacompleteburstfracture(typeAOA3.3)ofT8withaslight,yetclinicalunapparentnarrowingofthespinalcanalandastableT5fracture(typeAOA1.2).Despiteanalgesiawithmorphine,conservativetreatmentfailedanditwasnotpossibletomobilizethepatient.Hence,ananteriorthoracoscopic-assistedreductionandstabilizationinleftlateralpositionwithsinglelungventilationwasperformedasthetherapyofchoice.Intraoperatively,thebodyofT8wasremovedandplatewasusedtostabilizeandreducethefracture.Finally,atricorticaliliacbonegraftwasimplantedintothebonydefect.Intraoperativefluoroscopywasmerelyusedtoverifythepositioningoftheimplants.Postoperativeexaminationofthefoetusrevealednormalfindings.Thepatientwasdischargedwithparacetamolasresidualpainmedication.ThedegreeofkyphosisoftheT8fracturewassuccessfullyreducedfrom20°to13°(segmentalstandardvalue12°).Furtherclinicalandradiologicalcourseofthepatientwasuneventful.Ifsuitableimplantsareavailableandgoodbonestructureexists,solelyanteriorthoracoscopic-assistedreductionandstabilizationofanunstablethoracicburstfracturecanbeperformedsafely.Inthepresentcase,itwaspossibletoavoidintraoperativepronepositioningofthepregnantpatientaswellasreachingaminimumofradiationexposure...

[学科分类] 骨科学

[关键词] Pregnancy ;Burst fracture ;Thoracolumbar spine ;Anterior surgery ;Thoracoscopic spine surgery