Medical Student University of Pittsburgh Medical Center Pittsburgh, Pennsylvania, United States
Introduction: The literature is limited with respect to discussing the management of spinal pathologies during pregnancy. Pregnancy induces changes in both the physiology and spine anatomy, adding complexity to the neurosurgical management in this population. As such, the management of emergent spinal pathologies requiring surgical intervention is discussed in the context of third trimester pregnancy.
Methods: Three examples of acute spinal pathology are discussed: epidural spinal needle fracture while delivering anesthesia during labor, epidural abscess, and disc herniation causing acute neurologic deficit. All patients were in the third trimester of pregnancy. The epidural needle fracture was managed with exploration under local anesthesia followed by vaginal delivery. The epidural abscess and acute disc herniation were managed by cesarean delivery and then flipping the patient to do a posterior approach laminectomy with abscess evacuation and discectomy, respectively.
Results: All three cases resulted in resolution of neurosurgical pathology for the mother and delivery of a healthy baby. The first step in managing spinal neurosurgical emergencies in late pregnancy is ensuring hemodynamic stability of the mother. If surgical intervention is indicated, either general or local anesthesia can be used based on surgical extent and patient tolerability. For cases of pending neurological compromise, such as foreign bodies, local anesthesia in the lateral decubitus position can be utilized followed by a normal course of labor. For cases with acute neurological deficit, the supine position with general anesthesia can be utilized, followed by emergent cesarean section and then neurosurgical intervention in the prone position.
Conclusion : Several factors such as neurosurgical pathology, surgical approach, choice of anesthesia, and maternal/fetal medical stability must be taken into account when managing acute spinal pathologies in pregnant populations. This necessitates multidisciplinary input for a successful resolution.
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