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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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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.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Hungarian Defense Forces Medical Centre, 44. Robert Karoly krt., Budapest, 1134, Hungary

    Viktor Zsolt Kovari

  2. Department of Anesthesiology and Intensive Care, Hungarian Defense Forces Medical Centre, 44. Robert Karoly krt., Budapest, 1134, Hungary

    Laszlo Horvath

Authors
  1. Viktor Zsolt Kovari
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  2. Laszlo Horvath
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Corresponding author

Correspondence to Viktor Zsolt Kovari.

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Conflict of interest

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

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Kovari, V.Z., Horvath, L. Surgical management of cauda syndrome in third trimester of pregnancy focusing on spinal anesthesia and right lateral positioning during surgery as possible practices. Eur Spine J 27 (Suppl 3), 483–488 (2018). https://doi.org/10.1007/s00586-018-5519-y

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  • DOI: https://doi.org/10.1007/s00586-018-5519-y

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