Thoracic Segmental Spinal Anesthesia for Upper Thoracic Spine Fractures: A Case Series

Area of Science:

• Neurosurgery
• Anesthesiology
• Spinal Surgery

Background:

• Unstable upper thoracic spine fractures (T1-T6) present management challenges, often with associated injuries.
• General anesthesia (GA) with intubation poses risks for patients with chest injuries or comorbidities.
• Spinal anesthesia (SA) offers benefits like reduced blood loss and enhanced recovery.

Observation:

• Thoracic segmental SA (TSSA) provides targeted pain relief for awake prone positioning.
• A case series evaluated TSSA for unstable upper thoracic fracture fixation in five high-risk patients.
• Patients had comorbidities including chest injuries and cardiovascular/respiratory issues.

Findings:

• Surgical fixation of unstable upper thoracic spine fractures using TSSA was feasible and safe.
• Postoperative recovery was uneventful, with no neurological deterioration or need for mechanical ventilation.
• Follow-up ranged from 13 to 30 months.

Implications:

• TSSA may be a viable alternative to GA for high-risk patients undergoing upper thoracic spine surgery.
• Further large-scale, controlled trials are necessary to confirm TSSA's efficacy and safety.
• This approach could improve outcomes for complex spinal fracture management.