Thoracolumbar distraction fractures in advanced pregnancy: a contribution of two case reports

Thoracolumbar trauma in pregnant women is an important topic, though rarely discussed in the pertinent literature. Two consecutive cases of thoracolum bar distraction injuries in advanced pregnancy are presented. Conservative treatment failed in both cases; surgical management was necessary on a dela yed basis using compression instrumentation. The similar features of the pa ttern of injury in the two patients suggest a cushioning effect of the grav id uterus. A theoretical analysis of the pathomechanics is carried out in a n attempt to explain the specificity of flexion-distraction injuries in vic tims in an advanced stage of pregnancy. The authors suggest that the spine pivots about the fetus, and so is injured more in tension than in compressi on. The damage is mainly to soft-tissue structures, while anterior column c ompression and axial loading are less important.