Surgical management of cauda syndrome in third trimester of pregnancy focusing on spinal anesthesia and right lateral positioning during surgery as possible practices
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This article presents a surgical solution of a lumbar disc hernia of a pregnant woman focusing on the use of right lateral positioning, spinal anesthesia which has not previously been utilized in third trimester and discusses positioning options, and possible anesthesia methods with the surgical procedure options.
A left-sided L5/S1 lumbar disc hernia (verified by magnetic resonance imaging) of a 35-year-old, 32-week-pregnant woman with a deteriorating neurological status leading to cauda syndrome was treated successfully by microdiscectomy in right lateral position applying spinal anesthesia.
So far examples are given for almost every possible patient position in the third trimester except the right lateral one. All the previously presented positionings (prone, left lateral) were equally effective regarding the outcome with none being better than another. For left-sided lumbar pathologies performed in the third trimester the right lateral position might be an alternative option for easier access. Based on the literature an epidural and general anesthesia can be applied successfully in the third trimester. Spinal anesthesia might be another anesthesia consideration.
KeywordsLumbar disc herniation Pregnancy Cauda syndrome Spinal anesthesia Right lateral position
Compliance with ethical standards
Conflict of interest
Viktor Zsolt Kovari and Laszlo Horvath declare that they have no conflict of interest.
- 29.Eldridge J (2016) Obstetric anaesthesia and analgesia. In: Allman KG, Wilson IH, O’Donnell A (eds) Oxford handbook of anaesthesia, 4th edn. Oxford University Press, New York, pp 715–781Google Scholar
- 31.Towne EB (1926) Laminectomy and removal of spinal cord tumors under local anesthesia. Calif West Med 24:194Google Scholar
- 33.Elton CD, May A, Buggy DJ (2007) Obstetric anaesthesia and analgesia. In: Aitkinhead AR, Smith G, Rowbotham DJ (ed) Textbook of anaesthesia, 5th edn. Churchill Livingstone, London, pp 617–652Google Scholar
- 34.Frölich MA (2013) Obstetric anesthesia. In: Butterworth JF, Mackey DC, Wasnick JD (eds) Morgan and Mikhail’s clinical anesthesiology, 5th edn. McGraw-Hill Education/Medical, New York, pp 843–876Google Scholar