Positioning issues of spinal surgery during pregnancy

Posterior decompression and stabilization in a pregnant patient with traumatic lumbar fracture: A case report

Spine fractures with or without spinal cord injury in the pregnant population are rare, with few reported cases. A 25-year-old primigravida at 24 weeks of gestation presented after falling off a fast-moving motorcycle one month prior. She had sustained a severe back injury and had difficulty walking. Magnetic resonance imaging showed an acute kyphosis secondary to comminuted anterior wedge compression fractures of the L2 and L3 vertebral bodies and L2/3 disc involvement with retropulsion of the fracture fragments into the central canal resulting in severe central canal stenosis. After multidisciplinary discussion, the patient underwent posterior decompression, reduction and stabilization with pedicle screws. The patient had good neurological recovery at discharge and the pregnancy progressed normally. Three months later, at 39 weeks of gestation, the patient had an uneventful spontaneous delivery of a healthy baby. This case illustrates the importance of multidisciplinary management of spinal cord injury in a pregnant patient.

Management Challenges of Metastatic Spinal Cord Compression in Pregnancy

Primary and secondary spinal tumours with cord compression often represent a challenging condition for the patient and clinicians alike, even more so during pregnancy. The balance between safe delivery of a healthy baby and management of the mother's disease bears many clinical, psychological, and ethical dilemmas. Pregnancy sets a conflict between the optimal surgical and oncological managements of the mother's tumour and the well-being of her foetus. We followed the CARE guidelines from the EQUATOR Network to report an exemplificative case of a 39-year-old woman with a 10-year history of breast cancer, presenting in the second trimester of her first pregnancy with acute onset severe thoracic spinal instability, causing mechanical pain and weakness in lower limbs. Neuroradiological investigations revealed multilevel spinal deposits with a pathological T10 fracture responsible for spinal cord compression. The patient was adamant that she wanted a continuation of the pregnancy and her baby delivered. After discussion with her oncologist and obstetrician, we agreed to perform emergency spinal surgery—decompression and instrumented fixation. The literature search did not reveal a similar case of spinal metastatic breast cancer undergoing spinal instrumentation and delivery of a healthy baby a few months later. Following the delivery, the patient had further oncological treatment, including chemotherapy and radiotherapy. The paucity of such reports prompted us to present this case and highlight the relevance of a multidisciplinary approach involving obstetrician, oncologist, spinal surgeon, and radiologist to guide the optimal decision-making process.