Successful management of an unstable Jefferson fracture in pregnancy

Einleitung und Fragestellung Atlas fractures are triggered by axial force on the stretched neck, which can lead to bursting of the atlas arch. In unstable fractures, compression of the spinal cord might lead to neurological deficits. The purpose of this presentation is to demonstrate the interdisciplinary management of a rare case of an atlas fracture in pregnancy.

Material und Methodik We report a case of a 38-year-old G3P1, presenting at our emergency room with severe neck pain after collapsing and falling with her neck on the back of a chair at home. There were no signs of paresthesia or functional loss. Previous obstetric history included one at term delivery and one early miscarriage. There was no history of medical disorders or drug intake.

Ergebnisse After stabilization and first aid through the paramedics the patient was delivered to the hospital. The imaging, including CT and MRI scans, revealed an unstable, Jefferson type IIIb burst multifragmenting fracture without further injuries of soft tissue or the spinal canal. A Halo fixation device with a vest was applied immediately. The patient received respiratory-distress-syndrome prophylaxis, daily cardiotocography and regular ultrasound scans. Her vest had to be adjusted once, due to abdominal growth. Caesarean section was performed at 34+0 weeks of gestation and a healthy male was delivered. Five days after delivery dynamic osteosynthesis with dorsal screw-plate-system was performed. The postoperative CT scans revealed no signs of inflammation, loosening of the pedicle screws, foraminal or spinal stenosis and the patient was discharged on the seventh postoperative day with a hard cervical collar. In the follow-up the patient presented fully recovered without residual sensorimotor deficits.

Zusammenfassung An effective interdisciplinary emergency management is crucial for an optimal obstetric and orthopedic outcome of complicated atlas fractures in pregnancy.

 

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Publication History

Article published online:
29 August 2023