gms | German Medical Science

Objective: Spinal diseases that require urgent surgical treatment are rare during pregnancy. There are many aspects that must be taken into account in such situations. To date, only a few case reports have been conducted on this issue.

Methods: The retrospective study included consecutive pregnant patients who underwent spinal surgery at 2 neurosurgical high volume centers between 2010 and 2016.

Results: Overall 15 pregnant patients were assigned to acute spinal surgery. Among them, 2 underwent preoperative caesarian section in the 35th and 32th week, respectively. The other 13 patients underwent surgery during pregnancy. 2 patients were operated twice during the same pregnancy. The median age was 32 years (min 22, max 41). The median gestational age was 15 weeks (min 8, max 35). The indications were: n=6 lumbar herniated discs presenting with cauda equina syndrome in 3 cases, high graded motor deficit in 2 cases, and acute pain in 1 case; n=4 unstable injuries; n=1 intramedullary tumor with paraparesis; n=1 infection; n=1 nerve root schwannoma presenting with higher graded paresis. Perioperative pregnancy monitoring was done with an ultrasound or ultrasound plus CTG after the 25th week of gestation. All surgeries were performed under general anesthesia (balanced anesthesia n=12, TIVA n=3). Median duration of surgery was 100 minutes (min 41, max 240). 8 patients were placed in a prone position and 5 in a lateral decubitus position depending on the gestational age and the type of surgery. In 5 cases no intraoperative fluoroscopy was done, in 8 cases fluoroscopic verificiation of spine level or guidance of instrumentation was performed with a median fluoroscopic time of 6 seconds (min 1, max 40). No postoperative surgical complications occurred. One polytraumatized patient underwent medical abortion after radiation exposure, which was conducted before the pregnancy was diagnosed. Among other 12 patients, 2 suffered transient gestational diabetes, and 1 presented with vaginal bleeding without any signs for threatened abortion. According to our current follow up, no miscarriages, stillbirths or other severe obstetric complications occurred during the further pregnancy. All patients improved neurologically after the surgery.

Conclusion: Spine surgery during pregnancy seems to be generally safe. Nevertheless the indication should be strict and reserved for emergency cases. For pregnant patients the surgical strategy should be individually tailored for the mother and the fetus.