Resident Physician Atrium Health Wake Forest Baptist Winston-Salem, North Carolina, United States
Case Diagnosis: T3 and T4 Compression Fractures Successfully Treated with a Combination of Kyphoplasty and Medial Branch Blocks
Case Description: A 33-year-old female (she/her) aerospace physical therapist developed acute, non-radiating thoracic back pain following aerospace high-G centrifuge training. Imaging revealed T3 and T4 compression fractures without neuroforaminal or spinal canal involvement. Initial management involving physical therapy with a combination of NSAIDS and narcotics were unsuccessful, leading to kyphoplasty of the affected vertebrae. Though 50% pain relief was achieved, residual neck pain persisted. C7-T4 medial branch blocks were trialed resulting in approximately 80% symptom relief immediately post-procedure. She now continues to perform her occupation with minimal disruptions to her flying career.
Discussions: High-G centrifuge training is critical for preparing aviators but poses risks for musculoskeletal injuries, especially to the axial skeleton. Compression fractures of the thoracic spine are rare but may occur due to the intense axial loading. Early identification and interventional management, as demonstrated in this case, can significantly reduce pain and help maintain aviator readiness. The use of medial branch blocks provided substantial symptom relief, delaying the need for more invasive surgical options such as spinal fusion, which could have impacted the patient's functionality, let alone her flying career.
Conclusions: This case highlights the complexity of managing spinal injuries in high-G centrifuge training, where prompt intervention and rehabilitation are crucial for recovery and maintaining operational capacity. Tailoring treatment to minimize the impact on aviators' duties is essential, as demonstrated by the patient's continued ability to pursue her career with minimal disruption. Trialing medial branch blocks for thoracic compression fractures should be considered prior to pursuing other more invasive techniques.
