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BMJ Case Reports 2018; doi:10.1136/bcr-2018-225293
  • Unexpected outcome (positive or negative) including adverse drug reactions
  • CASE REPORT

Uncommon cause of chest pain in a postoperative spinal patient

  1. Rajesh Dwivedi
  1. Health Care for Older People, Nottingham University Hospitals NHS Trust, Nottingham, UK
  1. Correspondence to Dr Rajesh Dwivedi, rajesh.dwivedi{at}nuh.nhs.uk
  • Accepted 30 August 2018
  • Published 14 September 2018

Summary

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.

Footnotes

  • Contributors Sole author.

  • Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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