title: 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 thoracoscopic-assisted 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.
authors.affiliation: Center for Spinal Surgery and Neurotraumatology, BG Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389 Frankfurt am Main, Germany. klaus.schnake@bgu-frankfurt.de
authors.forename: Klaus John
authors.initials: KJ
authors.lastname: Schnake
authors.forename: Matti
authors.initials: M
authors.lastname: Scholz
authors.forename: Andreas
authors.initials: A
authors.lastname: Marx
authors.forename: Reinhard
authors.initials: R
authors.lastname: Hoffmann
authors.forename: Frank
authors.initials: F
authors.lastname: Kandziora
mesh_terms: D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D011256:Pregnancy Outcome; D011859:Radiography; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013904:Thoracic Vertebrae / Q000293:injuries* / Q000473:pathology / Q000601:surgery*; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult