Vicki M Butenschoen1, Hanna Hitscherich2, Sven O Eicker3, Silvia M Lobmaier4, Judith Rösler5, Martin Bretschneider6, Jan S Kirschke7, Peter Vajkoczy5, Nikolaus Kögl8, Paul Constanthin9, Claudius Thome8, Enrico Tessitore9, Bernhard Meyer2, Maria Wostrack2. 1. Department of Neurosurgery, Klinikum Rechts Der Isar, Technical University, Ismaningerstr. 22, 81675, Munich, Germany. Vicki.Butenschoen@tum.de. 2. Department of Neurosurgery, Klinikum Rechts Der Isar, Technical University, Ismaningerstr. 22, 81675, Munich, Germany. 3. Department of Neurosurgery, UKE Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg-Eppendorf, Germany. 4. Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany. 5. Department of Neurosurgery, Universitätsklinikum Charité, Charitéplatz 1, 10117, Berlin, Deutschland. 6. Department of Anesthesiology, Klinikum Rechts Der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany. 7. Department of Neuroradiology, Klinikum Rechts Der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany. 8. Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria. 9. Department of Neurosurgery, Hopitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
Abstract
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.
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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