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

Unstable upper thoracic spine (T1-T6) fractures pose a considerable challenge in their management. These cases are often complicated by associated injuries. These types of thoracic fractures need early stabilization and surgical fixation, which have been shown to improve recovery and accelerate neurological outcomes. Traditional general anesthesia (GA) with endotracheal intubation carries risks of postoperative pulmonary complications in patients with chest injuries or comorbidities. Spinal anesthesia (SA) has advantages over GA in terms of decreased blood loss, early enhanced recovery, and reduced risk of hazards associated with the prone position. Thoracic segmental SA (TSSA), which involves the targeted administration of local anesthetic near the surgical site, provides effective pain relief and allows for awake prone positioning without intraoperative complications or the need for conversion to GA. This case series explores the feasibility and safety of TSSA for the surgical fixation of unstable upper thoracic spine fractures in five patients with significant comorbidities, including chest injuries and cardiovascular or respiratory issues. Postoperative courses were uneventful, with no neurological deterioration or need for mechanical ventilation at follow-up (13-30 months). These preliminary findings suggest TSSA as a potential alternative to GA for high-risk patients undergoing upper thoracic spine surgery, but larger, controlled trials are needed to establish its efficacy and safety.