title: Spondyloptotic fracture of the cervical spine in a pregnant, anemic Jehovah's Witness: technical and ethical considerations. Case report.
abstract: The authors present the case of a 15-year-old Jehovah's Witness with a hematocrit level of 19% who was 4 months pregnant and had a two-level spondyloptotic cervical spine fracture. The patient was transferred to Georgetown University Medical Center with C-5 quadriplegia 3 weeks after having been injured in an automobile collision. The neurosurgical issues in this case included addressing a rare cervical spine injury, assessing and treating a vertebral artery injury, and performing surgery on a pregnant minor with severe anemia who held strong Jehovah's Witness beliefs. An ethics consultation was convened to determine the validity of a pregnant minor's refusal to undergo transfusion on the grounds of her religious beliefs. This case illustrates the potential benefits of thorough technical and ethical evaluations and reveals how they may contribute to the delivery of care in complex neurosurgical cases. To the authors' knowledge, this is the first two-level spondyloptotic cervical spine fracture dislocation to be reported in the literature. The added complexities of the case, given that the patient was an anemic, adolescent, pregnant Jehovah's Witness who refused blood transfusion, also appear to be unprecedented.
authors.affiliation: Department of Neurosurgery, and Center for Clinical Bioethics, Georgetown University Medical Center, Washington, D.C. 20007, USA.
authors.forename: F
authors.initials: F
authors.lastname: Feigenbaum
authors.forename: D P
authors.initials: DP
authors.lastname: Sulmasy
authors.forename: E D
authors.initials: ED
authors.lastname: Pellegrino
authors.forename: F C
authors.initials: FC
authors.lastname: Henderson
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D000747:Anemia, Hypochromic / Q000150:complications*; D002574:Cervical Vertebrae / Q000293:injuries*; D002835:Christianity; D004992:Ethics, Medical; D005260:Female; D006801:Humans; D010344:Patient Advocacy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000601:surgery*; D011250:Pregnancy Complications, Hematologic; D011253:Pregnancy in Adolescence; D016103:Spinal Fractures / Q000150:complications* / Q000601:surgery*