Advertisement

European Spine Journal

, Volume 27, Supplement 3, pp 483–488 | Cite as

Surgical management of cauda syndrome in third trimester of pregnancy focusing on spinal anesthesia and right lateral positioning during surgery as possible practices

  • Viktor Zsolt Kovari
  • Laszlo Horvath
Case Report

Abstract

Purpose

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.

Methods

Case report.

Results

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.

Conclusions

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.

Keywords

Lumbar disc herniation Pregnancy Cauda syndrome Spinal anesthesia Right lateral position 

Notes

Compliance with ethical standards

Conflict of interest

Viktor Zsolt Kovari and Laszlo Horvath declare that they have no conflict of interest.

References

  1. 1.
    LaBan MM, Rapp NS, Van Oeyen P et al (1995) The lumbar herniated disk of pregnancy: a report of six cases identified by magnetic resonance imaging. Arch Phys Med Rehabil 76:476–479CrossRefPubMedGoogle Scholar
  2. 2.
    Brown MD, Brookfield KF (2004) Lumbar disc excision and cesarean delivery during the same anaesthesia. A case report. J Bone Jt Surg Am 86A:2030–2032CrossRefGoogle Scholar
  3. 3.
    Garmel SH, Guzelian GA, D’Alton JG, D’Alton ME (1997) Lumbar disk disease in pregnancy. Obstet Gynecol 89:821–822CrossRefPubMedGoogle Scholar
  4. 4.
    Hakan T (2012) Lumbar disk herniation presented with cauda equina syndrome in a pregnant women. J Neurosci Rural Pract 3(2):197–199CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Brown M, Levi A (2001) Lumbar surgery during pregnancy. Spine 26:440–443CrossRefPubMedGoogle Scholar
  6. 6.
    Geftler A, Sasson A, Shelef I, Perry ZH, Atar D (2015) Cauda equina syndrome in a 36 week gravida patient. Isr Med Assoc J 17:522–523PubMedGoogle Scholar
  7. 7.
    Kim HS, Kim SW, Lee SM, Shin H (2007) Endoscopic discectomy for cauda equina syndrome during third trimester of pregnancy. J Korean Neurosurg Soc 42:419–420CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Kathirgamanathan A, Jardine AD, Levy DM, Grevitt MP (2006) Lumbar disc surgery in the third trimester—with fetus in utero. Int J Obstet Anaesth 15:181–182CrossRefGoogle Scholar
  9. 9.
    Capitan BA, Toran MM (2006) The cauda equina syndrome in pregnant woman with a massive disc herniation. Int J Obstet Anesth 15:181–182CrossRefGoogle Scholar
  10. 10.
    Abou-Shameh MA, Dosani D, Gopal S, McLaren AG (2006) Lumbar discectomy in pregnancy. Int J Gynecol Obstet 92:167–169CrossRefGoogle Scholar
  11. 11.
    Scott PJ (1965) Bladder paralysis in cauda equina lesions from disc prolapse. J Bone Jt Surg Br 47:224–235CrossRefGoogle Scholar
  12. 12.
    Lee JM, Han IH, Moon SH, Choi BK (2011) Surgery for recurrent lumbar disc herniation during pregnancy: a case report. Korean J Spine 8:304–306CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Heaman MI, Blanchard JF, Gupton AL, Moffatt MR, Currie RF (2005) Risk factors for spontaneous preterm birth among aboriginal and non-aboriginal women in manitoba. Pediatr Perinat Epideomiol 19:181–193CrossRefGoogle Scholar
  14. 14.
    Pike IL (2005) Maternal stress and fetal responses: evolutionary perspectives on preterm delivery. Am J Hum Biol 17:55–65CrossRefPubMedGoogle Scholar
  15. 15.
    Hayakawa K, Mizutani J, Suzuki N, Haas C, Kondo A, Otsuka S, Fukuoka M, Otsuka T (2017) Surgical management of the pregnant patient with lumbar disc herniation in the later stage of second trimester. Spine (Phila Pa 1976) 42:186–189CrossRefGoogle Scholar
  16. 16.
    IIyilikçi L, Erbayraktar s, Tural AN, Celik M, Sannav S (2004) Anesthetic management of lumbar discectomy in a pregnant patient. J Anaesth 18:45–47CrossRefGoogle Scholar
  17. 17.
    Vougioukas VI, Kyroussis G, Glasker S et al (2004) Neurosurgical intervention during pregnancy and puerperium: clinical considerations and management. Acta Neurochir 146:1287–1291 (discussion 91–2) CrossRefPubMedGoogle Scholar
  18. 18.
    Han IH, Kuh SU, Kim JH et al (2008) Clinical approach and surgical strategy for spinal diseases in pregnant women: a report of ten cases. Spine (Phila Pa 1976) 33:E616–E619CrossRefGoogle Scholar
  19. 19.
    Martel CG, Volpi-Abadie J, Ural K (2015) Anesthetic management of the parturient for lumbar disc surgery in the prone position. Ochsner J 15:259–261PubMedPubMedCentralGoogle Scholar
  20. 20.
    Gupta P, Gurumurthy M, Gangineni K, Anarabasu A, Keay SD (2008) Acute presentation of cauda syndrome in the third trimester of pregnancy. Eur J Obstet Gynecol Reprod Biol 140(2):279–281CrossRefPubMedGoogle Scholar
  21. 21.
    Al-areibi A, Coveney L, Singh S, Katsiris S (2007) Case report: anaesthetic management for sequential cesarean delivery and laminectomy. Can J Anaesth 54:471–474CrossRefPubMedGoogle Scholar
  22. 22.
    Mills GH, Chaffe AG (1994) Sleeping positions adopted by pregnant women of more than 30 weeks gestation. Anaesthesia 49:249–250CrossRefPubMedGoogle Scholar
  23. 23.
    Bamber JH, Dresner M (2003) Aortocaval compression in pregnancy: the effect of changing the degree and direction of lateral tilt on maternal cardiac output. Anesth Analg 97:256–258CrossRefPubMedGoogle Scholar
  24. 24.
    Bajwa SJ, Bajwa SK (2013) Anaesthetic challenges and management during pregnancy: strategies revisited. Anesth Essays Res 7:160–167CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Reitman E, Flood P (2011) Anaesthetic considerations for non-obstetric surgery during pregnancy. Br J Anaesth 107:72–78CrossRefGoogle Scholar
  26. 26.
    LaBan MM, Viola S, Willium DA, Wang AM (1995) Magnetic resonance imaging of the lumbar herniated disc in pregnancy. Am J Phys Med Rehabil 74:59–91CrossRefPubMedGoogle Scholar
  27. 27.
    Douglas J, Choi D (2000) Spinal anaesthesia for obstetrics: discovery, rediscovery. Can J Anaesth 47:833–836CrossRefPubMedGoogle Scholar
  28. 28.
    Nejdlova M, Johnson T (2012) Anaesthesia for non-obstetric procedures during pregnancy. Contin Educ Anaesth Crit Care Pain 12:203–206CrossRefGoogle Scholar
  29. 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
  30. 30.
    Mergeay M, Verster A, Van Aken D, Vercauteren M (2015) Regional versus general anesthesia for spine surgery. A comprehensive review. Acta Anaesth Belg 66:1–9PubMedGoogle Scholar
  31. 31.
    Towne EB (1926) Laminectomy and removal of spinal cord tumors under local anesthesia. Calif West Med 24:194Google Scholar
  32. 32.
    Khan MB, Kumar R, Enam SA (2014) Thoracic and lumbar spinal surgery under local anesthesia for patients with multiple comorbidities: a consecutive case series. Surg Neurol Int 5(Suppl 3):S62–S65PubMedPubMedCentralGoogle Scholar
  33. 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. 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
  35. 35.
    Katz JD, Hook R, Barash PG (1976) Fetal heart rate monitoring in pregnant patients undergoing surgery. Am J Obstet Gynecol 125:267–269CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurosurgeryHungarian Defense Forces Medical CentreBudapestHungary
  2. 2.Department of Anesthesiology and Intensive CareHungarian Defense Forces Medical CentreBudapestHungary

Personalised recommendations