The left lateral decubitus position as a safe and effective alternative for posterior lumbar fixation in Pregnancy: A technical Note

Spinal trauma during pregnancy is rare and technically challenging due to maternal–fetal risks. Positioning for posterior fixation in advanced gestation is problematic because prone positioning risks aortocaval compression. Case/Technique: We report emergency posterior fixation for a burst fracture of L1 in a 40-year-old woman at 24 weeks’ gestation. Short-segment fixation was performed from D12 to L2 in the left lateral decubitus position to avoid vena cava compression. Free-hand pedicle screws were placed using anatomical landmarks and tactile feedback, with limited laminectomy and single-shot fluoroscopy under abdominal shielding. Outcome: Recovery was uneventful. Urinary retention resolved within 6 days. The patient delivered vaginally at term, and 36-month follow-up confirmed stable fixation without maternal or neonatal complications. The left lateral decubitus position is a feasible and safe alternative to prone positioning for lumbar fixation in advanced pregnancy. Multidisciplinary collaboration, radiation minimization, and precise free-hand technique are essential for achieving favorable outcomes.