Management of a Pregnant Patient with a Burst Fracture Causing Neurologic Injury

Abstract

A thoracolumbar fracture in a pregnant patient is uncommon and is generally associated with relative osteoporosis of pregnancy1,2. We know of only one report that has addressed traumatic thoracolumbar fractures in pregnant women3. That study described two patients who had a flexion-distraction fracture treated in a delayed fashion, and neither of them had a neurologic deficit. We describe the treatment of a thirty-nine-year-old woman with a burst fracture of the twelfth thoracic vertebra with an incomplete spinal cord injury and a viable pregnancy. We believe this to be the first report of the surgical treatment of a traumatic fracture associated with a spinal cord injury in a pregnant woman. The patient was informed that data concerning the case would be submitted for publication, and she consented. A thirty-nine-year-old woman who was seventeen weeks pregnant fell from a standing height on the day prior to presentation after she had been consuming alcohol and marijuana. She presented to the emergency department the following day because of wrist and back pain. The medical and surgical history was notable for paranoid schizophrenia and a previous cesarean delivery. She denied taking any prescription medications or having any allergies. At the time of the initial presentation, the patient had a distal radial fracture and back pain. The back pain was not further evaluated, given the low level of trauma and the pregnant status of the patient. The distal radial fracture was reduced, and a cast was applied. She was discharged with instructions to return for follow-up of the wrist. The patient returned to the emergency department the next day with worsening back pain and new complaints of lower extremity weakness as well as urinary and fecal incontinence. At that time, a magnetic …