Uncommon cause of chest pain in a postoperative spinal patient

Abstract

An 84-year-old woman with previous spinal operations including vertebroplasty and lumbar decompressions was admitted electively under the spinal team for right-sided L4/5 decompression for worsening back pain which she undergoes using a posterior approach. Postoperatively, she develops stabbing upper central chest pain and given unremarkable chest X-ray, ECG and cardiac troponin, she undergoes a CT pulmonary angiogram which shows a fracture of the upper part of sternum but no pulmonary embolism. There is no history of recent trauma and this is deemed to be secondary to prolonged spinal surgery in the prone position in a patient with osteopenic bones. To date, we have not come across a case of spontaneous sternal fracture as a complication of spinal surgery at our regional spinal unit. Most cases of sternal fractures are secondary to blunt anterior chest wall trauma with spontaneous fractures and stress fractures being rare.

Keywords: osteoporosis; pain; spinal cord.

Figure 1

Post-op spinal X-ray following L4/5 stabilisation.

Figure 2

Chest X-ray (AP semi-erect) post-op day 1 to investigate her chest pain.

Figure 3

CT pulmonary angiogram showing the sternal fracture in the superior portion of the body of the sternum marked by an arrow.

Figure 4

Isotope bone scan scintigraphy image showing increased uptake at the site of the sternal fracture and at the site of spinal surgery marked by arrows.