Spine surgery in pregnant women: a multicenter case series and proposition of treatment algorithm

Spine surgery in pregnant women: a multicenter case series and proposition of treatment algorithm

Purpose Spinal diseases requiring urgent surgical treatment are rare during pregnancy. Evidence is sparse and data are only available in the form of case reports. Our aim is to provide a comprehensive guide for spinal surgery on pregnant patients and highlight diagnostic and therapeutic aspects. Met...

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Published in:European spine journal Vol. 30; no. 4; pp. 809 - 817
Main Authors: Butenschoen, Vicki M., Hitscherich, Hanna, Eicker, Sven O., Lobmaier, Silvia M., Rösler, Judith, Bretschneider, Martin, Kirschke, Jan S., Vajkoczy, Peter, Kögl, Nikolaus, Constanthin, Paul, Thome, Claudius, Tessitore, Enrico, Meyer, Bernhard, Wostrack, Maria
Format: Journal Article
Language:English
Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-04-2021
Springer Nature B.V
Subjects:
Back surgery
Bone surgery
Case reports
Cesarean section
Diabetes mellitus
Fetuses
Gestational age
Medical records
Medicine
Medicine & Public Health
Neurosurgery
Original Article
Paresis
Patients
Pregnancy
Spinal cancer
Spinal cord
Spine (lumbar)
Surgical Orthopedics
Vagina
Pregnancy
Spine surgery
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Summary:Purpose Spinal diseases requiring urgent surgical treatment are rare during pregnancy. Evidence is sparse and data are only available in the form of case reports. Our aim is to provide a comprehensive guide for spinal surgery on pregnant patients and highlight diagnostic and therapeutic aspects. Methods The study included a cohort of consecutive pregnant patients who underwent spinal surgery at five high-volume neurosurgical centers between 2010 and 2017. Perioperative and perinatal clinical data were derived from medical records. Results Twenty-four pregnant patients were included. Three underwent a preoperative cesarean section. Twenty-one patients underwent surgery during pregnancy. Median maternal age was 33 years, and median gestational age was 13 completed weeks. Indications were: lumbar disk prolapse ( n  = 14; including cauda equina, severe motor deficits or acute pain), unstable spine injuries ( n  = 4); intramedullary tumor with paraparesis ( n  = 1), infection ( n  = 1) and Schwann cell nerve root tumor presenting with high-grade paresis ( n  = 1). Two patients suffered transient gestational diabetes and 1 patient presented with vaginal bleeding without any signs of fetal complications. No miscarriages, stillbirths, or severe obstetric complications occurred until delivery. All patients improved neurologically after the surgery. Conclusion Spinal surgical procedures during pregnancy seem to be safe. The indication for surgery has to be very strict and surgical procedures during pregnancy should be reserved for emergency cases. For pregnant patients, the surgical strategy should be individually tailored to the mother and the fetus.
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ISSN:0940-6719
1432-0932
DOI:10.1007/s00586-021-06726-2