[Fracture dislocation of the thoracolumbar spine in pregnant patient: diagnostic by image and treatment]. / Fractura-luxación de columna toracolumbar en paciente gestante: diagnóstico por imagen y tratamiento.

ABSTRACT

BACKGROUND: Fracture dislocations of the thoracolumbar spine are, to a great extent, associated with neurologic deficit and instability, so a large percentage of them require surgical treatment. Being pregnant does not rule out the possibility of having this type of lesions. There are only a few bibliographic references concerning these cases and medical and treatment ignorance about them is frequent. OBJECTIVE: Present a review of concepts and specifications for the correct and safe imaging diagnosis as well as considerations on the surgical treatment of patients with traumatic thoracolumbar spine lesions who are pregnant. MATERIAL AND METHODS: A bibliographic review will be presented together with a clinical case of the CALRM, a 31-year-old female with a fracture dislocation at T12-L1, ASIA E, who at the time of the lesion was nine weeks pregnant, and was managed with a multidisciplinary approach that included the following services Obstetrics and Gynecology, Pediatrics, Anesthesiology, Radiology and Imaging, Legal Medicine, Spine Surgery, and the hospital's Ethics Committee. RESULTS: The diagnosis and characteristics of the lesion were assessed properly with standard X-rays and the support of MRI. The patient underwent posterior stabilization with a transpedicular system while she was pregnant, and bone graft harvesting and application with an anterior approach after the pregnancy, without any complications. CONCLUSIONS: The correct understanding of the nature of ionizing radiation allows using an acceptable dose range according to the study performed and the patient's gestational age. Any patient with a fracture dislocation of the thoracolumbar spine who can tolerate the procedure should be stabilized. Moreover, the fetal risks of the surgical and anesthetic procedure may be avoided with an appropriate selection of the technique and the anesthetic agents, as well as with continuous maternal and fetal monitoring.