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Clinical Conundrum: A Complex Case of Pott Disease in Pregnancy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:1289-1292. [PMID: 36375804 DOI: 10.1016/j.jogc.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/07/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022]
Abstract
Spinal tuberculosis (TB) is a rare form of extrapulmonary TB that can be clinically difficult to diagnose, particularly in pregnancy. This 24-year-old G2, P0 patient was diagnosed at 19 weeks gestation, 2 days after a protracted admission for hyperemesis gravidarum, COVID-19 infection, and unexplained transaminitis with bilateral lower limb weakness and urinary retention. She underwent emergent spinal decompression surgery with expectant management on intravenous antitubercular medication and cesarean delivery at 343 weeks gestation. Spinal tuberculosis is a difficult diagnosis, impacted by medical comorbidities, pregnancy, and diagnostic bias. This case describes successful antenatal management of spinal tuberculosis and highlights the importance of interdisciplinary care.
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Antolínez Ayala VE, García Arias MD, Bautista Vargas SE, Báez Cárdenas LM, Castellanos Peñaranda C. Paraplegia due to spinal meningioma during the third trimester of pregnancy: case report and literature review. Spinal Cord Ser Cases 2021; 7:31. [PMID: 33859165 DOI: 10.1038/s41394-020-00368-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/17/2020] [Accepted: 11/19/2020] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Spinal meningiomas represent 25-45% of intradural spinal tumors and ~2% of meningiomas of the central nervous system (CNS), and their occurrence during pregnancy is unusual. We present an updated literature review. CASE REPORT A 36-year-old woman, at 32.6 weeks of gestation, was hospitalized for urinary tract infection and urinary retention. One month earlier, she had decreased strength in lower limbs, and this weakness rapidly progressed to flaccid paraplegia without sphincters control. Magnetic resonance imaging (MRI) revealed a well-defined intradural extramedullary lesion in T3-T4. Using a posterolateral approach, the tumor was completely removed; however, there was no clinical improvement, and the patient was discharged with an impairment scale (AIS) grade A. Histopathology examination indicated a psammomatous meningioma. DISCUSSION Meningiomas are benign tumors that are slowly progressive; however, the hemodynamic and hormonal changes of pregnancy are related to their accelerated growth. Reports show that the onset of the symptoms during the third trimester of pregnancy, including early neurological symptoms or signs of spinal cord compression, can be easily attributed to those of pregnancy by both the patient and the doctor. The time to diagnosis and medulla compression time are thus prolonged, which can be further compounded in middle-high income countries due to limitations in obtaining images for evaluation. Although rare, spinal meningiomas should be considered in the differential diagnosis of patients with neurological symptoms during pregnancy. Their early recognition is important to avoid irreversible neurological damage.
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Zheng Q, Hu X, Zhang Y, Wang Y. Lumbar disc herniation in a pregnant woman treated with full-endoscopic interlaminar discectomy without X-ray exposure: A case report. J Orthop Sci 2021:S0949-2658(20)30336-5. [PMID: 33581926 DOI: 10.1016/j.jos.2020.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Qiangqiang Zheng
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, PR China
| | - Xiaojian Hu
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, PR China
| | - Yuzhu Zhang
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, PR China.
| | - Yue Wang
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, PR China.
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Spine surgery in pregnant women: a multicenter case series and proposition of treatment algorithm. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:809-817. [PMID: 33492487 DOI: 10.1007/s00586-021-06726-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/04/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
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.
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Spinal cord glioblastoma during pregnancy: Case report. Neurochirurgie 2020; 67:201-204. [PMID: 33232712 DOI: 10.1016/j.neuchi.2020.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/17/2020] [Accepted: 11/14/2020] [Indexed: 11/20/2022]
Abstract
Spinal Cord Glioblastoma Multiforme (SCGBM) is a very rare, debilitating and often fatal tumor. Cases of intracranial GBM during pregnancy have been reported, and as other tumor occurring in this setting, it harbors a great dilemma to attending physicians and families. We report the first case of a SCGBM diagnosed during pregnancy and discuss its management and treatment.
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Coşkun D, Mahli A, Sabuncu Ü, Özdemir R, Emmez H, Günaydın DB. Anaesthetic Management in Successive Spinal Surgeries During Pregnancy and Postpartum. Turk J Anaesthesiol Reanim 2020; 48:420-422. [PMID: 33103149 PMCID: PMC7556636 DOI: 10.5152/tjar.2020.31698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 08/21/2019] [Indexed: 11/22/2022] Open
Abstract
In this case report, we present a parturient with spinal tumour who required neurosurgery before and after caesarean delivery under general anaesthesia. A 25-year-old woman at 30 weeks of gestation and suffering from bilateral lower-limb weakness and sensory deficit due to spinal tumour underwent emergent laminectomy and decompression surgery under general anaesthesia. In this case, total intravenous anaesthesia was used. Two weeks later, the patient underwent emergent caesarean delivery under general anaesthesia due to preterm labour and gave birth to a healthy new-born. Meanwhile, pathological exam revealed soft tissue sarcoma requiring re-operation for gross total excision in the postpartum Week 4, which was followed by multisession chemoradiotherapy. The patient survived for 3 years, that is, until generalised systemic and neural metastasis. General anaesthesia management in surgeries before and after caesarean delivery in patients with spinal tumours is of utmost importance in providing optimal maternal, foetal and neonatal safety using a multidisciplinary team approach.
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Affiliation(s)
- Demet Coşkun
- Department of Anaesthesiology and Reanimation, Gazi University School of Medicine, Ankara, Turkey
| | - Ahmet Mahli
- Department of Anaesthesiology and Reanimation, Yüksek İhtisas University School of Medicine, Ankara, Turkey
| | - Ülkü Sabuncu
- Department of Anaesthesiology and Reanimation, Gazi University School of Medicine, Ankara, Turkey
| | - Rabia Özdemir
- Department of Anaesthesiology and Reanimation, Gazi University School of Medicine, Ankara, Turkey
| | - Hakan Emmez
- Department of Neurosurgery, Gazi University School of Medicine, Ankara, Turkey
| | - Dudu Berrin Günaydın
- Department of Anaesthesiology and Reanimation, Gazi University School of Medicine, Ankara, Turkey
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Kawaguchi K, Akeda K, Takegami N, Kurata T, Toriyabe K, Ikeda T, Sudo A. Cervical schwannoma in the early stage of pregnancy: a case report. BMC Surg 2020; 20:245. [PMID: 33081764 PMCID: PMC7576856 DOI: 10.1186/s12893-020-00903-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/08/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Although spinal schwannomas generally grow very slowly, it has been reported that these clinical growths and their associated neurological symptoms accelerate during pregnancy. Because these cases are rare, surgical intervention for this tumor during pregnancy poses a significant challenge. The change of pregnancy-related hormones, such as estrogen and progesterone, is considered to have an effect on the clinical symptoms of spinal tumors. Expressions of the receptors for estrogen and progesterone in orbital and vestibular schwannomas have been reported; however, those expressions in spinal schwannomas have not been examined. CASE PRESENTATION A 36-year-old woman at 8 weeks' gestation suffered from developing neck pain and neurological symptoms in the right upper extremity. Magnetic resonance imaging (MRI) confirmed the presence of a cervical intradural extramedullary tumor. Under general anesthesia, using intraoperative neurophysiological monitoring of motor-evoked potentials (MEPs), spinal tumor resection following a hemi-laminoplasty was performed in a prone position at 12 weeks gestation. The pathological diagnosis following surgery was spinal schwannoma. Her neurological symptoms were significantly improved after surgery and she delivered a healthy baby in her 40th week of pregnancy. At a 12-month follow-up, no abnormalities were observed during medical examinations of both mother and child. An immunohistochemical study identified the expression of estrogen receptors, but not progesterone receptors, in the spinal schwannoma. CONCLUSIONS A cervical spinal schwannoma was successfully removed under general anesthesia at 12 weeks gestation by coordination between orthopaedic, obstetric and anesthesia teams. For the first time, an immunohistochemical analysis showed that the expression of estrogen receptors was identified in spinal schwannoma cells, suggesting the possibility that these hormone receptors in spinal schwannoma might contribute to the worsening of neurological symptoms during pregnancy.
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Affiliation(s)
- Koki Kawaguchi
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Koji Akeda
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Norihiko Takegami
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Tatsuya Kurata
- Department of Orthopaedic Surgery, Sakakibara Onsen Hospital, 1033-4 Sakakibara town, Tsu, Mie, 514-1293, Japan
| | - Kuniaki Toriyabe
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Mie, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Mie, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
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Whiles E, Shafafy R, Valsamis EM, Horton C, Morassi GL, Stokes O, Elsayed S. The Management of Symptomatic Lumbar Disc Herniation in Pregnancy: A Systematic Review. Global Spine J 2020; 10:908-918. [PMID: 32905728 PMCID: PMC7485082 DOI: 10.1177/2192568219886264] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES Lumbar disc herniation (LDH) has been reported to affect 1 in 10 000 pregnant women. There is limited evidence available regarding the optimal management of LDH in pregnant patients. We aimed to review the current evidence for the management of symptomatic LDH in pregnancy through critical appraisal and analysis of the available literature. METHODS Searches were conducted in Medline, Embase, PubMed, Science Direct, and The Cochrane Library from inception using predetermined search terms. All peer-reviewed studies of pregnant women with symptomatic LDH were included. The quality of eligible articles was assessed and extracted data and characteristics were pooled for analysis. References cited by studies were screened to identify other relevant publications. RESULTS Thirty studies involving 52 patients were identified. Compared to surgically managed patients, conservatively managed patients had a higher full recovery rate (61.54% vs 56.41%) and reported a lower rate of persistent symptoms (30.77% vs 38.54%). Compared to patients who were treated surgically for cauda equina syndrome, patients treated surgically for sciatica had a higher full recovery rate (80.95% vs 27.78%) and reported a lower rate of persistent symptoms (14.29% vs 66.67%). CONCLUSION There is limited evidence to guide the management of pregnant patients with LDH. Despite a suggestion toward improved outcomes with conservative management, the presence of selection bias and the overall poor quality of current research precludes reliable conclusions from being drawn. Decision making for this patient group should be undertaken within a multidisciplinary setting.
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Affiliation(s)
- Emily Whiles
- Brighton & Sussex University Hospitals NHS Trust, Brighton,
UK
| | - Roozbeh Shafafy
- Royal London Hospital, Barts Health NHS Trust, London, UK,Roozbeh Shafafy, Department of Spinal
Surgery, Royal London Hospital, Barts Health NHS Trust, Whitechapel, London E1
1RD, UK.
| | | | - Chris Horton
- Sir William Dunn School of Pathology, University of Oxford, Oxford,
UK
| | | | - Oliver Stokes
- Royal Devon & Exeter NHS Foundation Trust, London, UK
| | - Sherief Elsayed
- Brighton & Sussex University Hospitals NHS Trust, Brighton,
UK,NMC Spine, Dubai, United Arab Emirates
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Esmaeilzadeh M, Hong B, Polemikos M, Al-Afif S, Hermann EJ, Scheinichen D, von Kaisenberg C, Hillemanns P, Krauss JK. Spinal Emergency Surgery During Pregnancy: Contemporary Strategies and Outcome. World Neurosurg 2020; 139:e421-e427. [PMID: 32305614 DOI: 10.1016/j.wneu.2020.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Low back pain is a common complaint during pregnancy. However, spinal pathologies, which manifest with severe pain, radiculopathy, and acute neurologic deficits because of disk herniation or mass lesions require special attention. Here, we present our interdisciplinary experience in the surgical management of spinal emergencies during pregnancy. METHODS The data of pregnant women who underwent surgery for spinal pathologies over a 10-year period were collected. Patient-related characteristics such as maternal age, gestational age, preoperative workup, signs and symptoms of mothers, and diagnostic procedures were evaluated. After an interdisciplinary conference, individualized treatment plans regarding available options were developed. Fetal Doppler and cardiotocography were obtained before and after surgery. RESULTS Nine pregnant women presented with spinal disorders and underwent spinal emergency surgery within the study period. The mean maternal age was 32.2 years. Six women presented with lumbar disk herniations manifesting as severe sciatica or foot drop and 3 patients had thoracic mass lesions resulting in cauda equine syndrome and/or ataxia. The mean gestational age at the time of presentation was 26.5 weeks. Caesarean sections were performed in 3 women prior to the neurosurgical procedure, whereas the pregnancies were maintained in the 6 other patients. Eight infants who were healthy at birth had an unremarkable development. CONCLUSIONS Surgery for spinal emergencies in pregnancy can be performed safely according to individual treatment plans developed by an interdisciplinary team taking into account the expectant mother's decision. Maintenance of pregnancy is possible and feasible in most patients.
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Affiliation(s)
| | - Bujung Hong
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Manolis Polemikos
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Shadi Al-Afif
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Elvis J Hermann
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Dirk Scheinichen
- Department of Anaesthesiology, Hannover Medical School, Hannover, Germany
| | | | - Peter Hillemanns
- Department of Gynaecology & Obstetrics, Hannover Medical School, Hannover, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
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Bongetta D, Versace A, De Pirro A, Gemma M, Bernardo L, Cetin I, Savasi V, Assietti R. Positioning issues of spinal surgery during pregnancy. World Neurosurg 2020; 138:53-58. [PMID: 32081820 DOI: 10.1016/j.wneu.2020.02.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Albeit rarely, different spinal pathologies may require surgical treatment during pregnancy. The management of such cases poses a series of challenges, starting with adequate body positioning. OBJECTIVE To illustrate limits and indications of the different surgical positioning strategies for pregnant women undergoing spine surgery. METHODS We performed a systematic review of literature about the described surgical positioning strategies used for spinal surgery during pregnancy, discussing advantages, indications, and limits. We also describe of a novel three-quarters prone positioning for dorsal pathology. RESULTS The surgical strategy may vary according to several factors, such as the location and the nature of the underlying pathology, the stage of the pregnancy, and the clinical condition of mother and fetus. During the second trimester, the habitus begins to raise issues about both the abdominal and the aortocaval compressions. The third trimester implies neonatal and ethical challenges: both fetal monitoring and the possibility of urgently proceeding to delivery should be guaranteed. The prone position is feasible during the second trimester provided an adequate frame is supplied. The lateral or three-quarters prone positioning may offer the safest option in the last stages of pregnancy, whereas both supine and sitting positionings are anecdotal. CONCLUSIONS Gestational age, surgical comfort and maternofetal safety should be balanced by a multidisciplinary team to tailor an adequate positioning plan for each individual case. The early third trimester is the more limiting period because of the womb hindrance favoring lateral or three-quarters positionings.
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Affiliation(s)
- Daniele Bongetta
- Neurosurgery Unit, Fatebenefratelli e Oftalmico Hospital, Milan, Italy.
| | | | | | - Marco Gemma
- Anesthesia and Intensive Care Unit, Fatebenefratelli e Oftalmico Hospital, Milan, Italy
| | - Luca Bernardo
- Pediatrics Unit, Fatebenefratelli e Oftalmico Hospital, Milan, Italy
| | - Irene Cetin
- Obstetrics and Gynecology Unit, "Ospedale dei bambini Vittore Buzzi" and University of Milan, Milan, Italy
| | - Valeria Savasi
- Obstetrics and Gynaecology Unit, "Luigi Sacco" Hospital and University of Milan, Milan, Italy
| | - Roberto Assietti
- Neurosurgery Unit, Fatebenefratelli e Oftalmico Hospital, Milan, Italy
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R Nalli U, Vaithiyanadhan S, Govindarajan HK, Muthu S. Radiation-Free Management of Lumbar Spine Burst Fractures in Pregnant Women: A Report of Two Cases. JBJS Case Connect 2019; 9:e0294. [PMID: 31743121 DOI: 10.2106/jbjs.cc.19.00294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CASE We present the strategies we used in surgical management of delayed presentation of traumatic lumbar fractures with neurological deficits in 2 young primigravida mothers in early trimesters of pregnancy. Posterior stabilization was achieved in a prone position using magnetic resonance imaging (MRI) without radiation. CONCLUSIONS Management of spinal cord injury in pregnancy is a delicate scenario in which risks and benefits of surgery have to be explained to the patient for whom surgical management is contemplated. Risk of radiation to the fetus is completely avoided by using MRI perioperatively to assess injury and outcome.
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Affiliation(s)
- Uvaraj R Nalli
- Institute of Orthopaedics and Traumatology, Rajiv Gandhi Government General Hospital, Chennai, India
| | | | | | - Sathish Muthu
- Institute of Orthopaedics and Traumatology, Rajiv Gandhi Government General Hospital, Chennai, India
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Abstract
Lower back pain is a commonly reported symptom during pregnancy. However, herniated lumbar disk disease is an uncommon cause for such pain. Cauda equina syndrome (CES) during pregnancy is a rare clinical scenario. This review highlights the epidemiology, diagnostic and treatment strategies, and challenges encountered when managing herniated lumbar disk disease and CES in pregnancy. Magnetic resonance imaging is the diagnostic modality of choice. Nonoperative treatment strategies are successful in the vast majority of cases in patients with a herniated disk in the absence of CES. CES and progressive neurological deficits remain absolute indications for surgical intervention regardless of gestational age. For such patients or those with debilitating symptoms refractory to nonoperative treatment strategies, surgery has been demonstrated to be safe in the pregnant patient population. However, surgery should be performed with obstetric and midwifery support should complications occur to the fetus.
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13
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Higgins MF, Pollard L, McGuinness SK, Kingdom JC. Fetal heart rate monitoring in nonobstetric surgery: a systematic review of the evidence. Am J Obstet Gynecol MFM 2019; 1:100048. [DOI: 10.1016/j.ajogmf.2019.100048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/26/2019] [Accepted: 09/22/2019] [Indexed: 12/29/2022]
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Yang S, Jiang WM, Yang HL. ALK-positive anaplastic large cell lymphoma of the thoracic spine occurring in pregnancy: A case report. World J Clin Cases 2019; 7:2857-2863. [PMID: 31616703 PMCID: PMC6789405 DOI: 10.12998/wjcc.v7.i18.2857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/06/2019] [Accepted: 08/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Anaplastic large cell lymphoma (ALCL) is a type of non-Hodgkin’s lymphoma (NHL). ALCL is rare as a bone lesion and in pregnancy.
CASE SUMMARY We present the first case of anaplastic lymphoma kinase (ALK)+ ALCL of the thoracic spine during pregnancy. A 25-year-old pregnant woman was presented to us at 24 wk’ gestation with severe back pain and weakness in the left lower limb. Imaging examination showed lesions at T10 and T11. She underwent posterior pedicle screw fixation and vertebroplasty. Pathological examination showed ALK+ ALCL. The patient chose to have therapeutic abortion after surgery and received chemotherapy in the hematology department. She now remains disease free with no neurological deficit after 30 mo’ follow-up.
CONCLUSION ALK+ ALCL with the thoracic spine involvement is uncommon, especially in pregnancy. Many symptoms can be misunderstood during pregnancy; therefore, when a pregnant patient has persistent back pain or lower limb neurological symptoms, imaging examinations should be performed.
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Affiliation(s)
- Sen Yang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
| | - Wei-Min Jiang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
| | - Hui-Lin Yang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
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Bitterman J, Donovan J, Lam M. Diagnosis and rehabilitation of a pregnant woman with spinal cord disorder due to spinal cord tumor. Spinal Cord Ser Cases 2019; 5:8. [PMID: 30701085 PMCID: PMC6345917 DOI: 10.1038/s41394-019-0153-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/10/2019] [Accepted: 01/12/2019] [Indexed: 12/17/2022] Open
Abstract
Introduction Spinal cord tumors are a rare cause of spinal cord disorder (SCD). Early diagnosis can be challenging, especially in patient populations with other potential etiologies for back pain, such as pregnant women. Case presentation A 28-year-old female presented at 8 weeks gestation with thoracic back pain initially diagnosed as gestational low back pain. Her symptoms progressed to lower extremity weakness. After diagnosis and resection of a spinal cord ependymoma, we collaborated with the inpatient interdisciplinary team to devise a rehabilitation program focused on minimizing pregnancy-related complications and optimizing care of a newborn in the setting of a new paraplegia. Discussion Providers should not assume all pregnant women with low back pain have gestational back pain, as it can be due to more insidious causes. The rehabilitation course for women who develop an SCD during gestation should be carefully tailored toward their pre- and post-natal care and with the education of how the disorder can affect pregnancy and parenting.
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Affiliation(s)
- Jason Bitterman
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ USA
| | - Jayne Donovan
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ USA
- Kessler Institute for Rehabilitation, West Orange, NJ USA
| | - Mylan Lam
- Kessler Institute for Rehabilitation, West Orange, NJ USA
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Zemmar A, Al-Jradi A, Ye V, Al-Kebsi I, Andrade-Barazarte H, Zemmar E, Avecillas-Chasin J, Cherian I, Krassioukov AV, Hernesniemi J. Medical and surgical management of acute spinal injury during pregnancy: A case series in a third-world country. Surg Neurol Int 2018; 9:258. [PMID: 30687569 PMCID: PMC6322169 DOI: 10.4103/sni.sni_380_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 11/13/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND There is scant literature describing the management of acute spinal injury in pregnant patients. Here, we report our experience with five cases of pregnant patients including three females who suffered acute traumatic spinal cord injuries (SCIs). METHODS This retrospective study evaluated five pregnant women presenting with traumatic spinal injuries over a 16-month period. All were assessed using the International Standards for Neurological Classification of Spinal Cord Injury Patients and the American Spine Injury Association Impairment Scale (AIS). RESULTS Three patients sustained SCIs: two cervical spine (C4 AIS-A and C5 AIS-B) and one thoracolumbar junction fracture dislocation (T11 AIS-A). Two patients required surgical stabilization during pregnancy, with one undergoing surgery after delivery. All three patients subsequently delivered healthy newborns. The remaining two patients without neurologic deficits at admission were treated conservatively; one had a healthy child, whereas the other patient aborted the baby due to the initial trauma. CONCLUSIONS Our study demonstrates that the same surgical principals may be applied to pregnant women as to routine patients with SCIs. Further studies with greater patient data should be performed to better develop significant guidelines for the management of pregnant patients with spinal injuries.
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Affiliation(s)
- Ajmal Zemmar
- Department of Neurosurgery, Juha Hernesniemi International Neurosurgery Center, Henan Provincial People's Hospital, 7 Weiwu Road, Zhengzhou, China
| | - Ahmed Al-Jradi
- Department of Neurosurgery, AL-Thawrah General Model Hospital, Sana’a, Yemen
- Department of Neurosurgery, Nobel Institute of Neuroscience, Nobel Medical College Teaching Hospital, Biratnagar, Nepal
| | - Vincent Ye
- Division of Neurosurgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ismail Al-Kebsi
- Department of Neurosurgery, AL-Thawrah General Model Hospital, Sana’a, Yemen
| | - Hugo Andrade-Barazarte
- Department of Neurosurgery, Juha Hernesniemi International Neurosurgery Center, Henan Provincial People's Hospital, 7 Weiwu Road, Zhengzhou, China
| | - Emal Zemmar
- Department of Neurosurgery, Juha Hernesniemi International Neurosurgery Center, Henan Provincial People's Hospital, 7 Weiwu Road, Zhengzhou, China
| | | | - Iype Cherian
- Department of Neurosurgery, Nobel Institute of Neuroscience, Nobel Medical College Teaching Hospital, Biratnagar, Nepal
| | - Andrei V. Krassioukov
- Department of Neurosurgery, International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Division of Physical Medicine & Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; G.F. Strong Rehabilitation Centre, Vancouver, British Columbia, Canada
| | - Juha Hernesniemi
- Department of Neurosurgery, Juha Hernesniemi International Neurosurgery Center, Henan Provincial People's Hospital, 7 Weiwu Road, Zhengzhou, China
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Neuroanesthesia and pregnancy: Uncharted waters. Med J Armed Forces India 2018; 75:125-129. [PMID: 31065178 DOI: 10.1016/j.mjafi.2018.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 10/15/2018] [Indexed: 12/16/2022] Open
Abstract
An incidence of 30-40 deaths per triennium in pregnant patients is reported because of brain pathology. Over the last two decades, the obstetric cause of mortality in the pregnant patient has declined, but the trend is rising for non-obstetric cause of mortality. Pregnancy is associated with a host of anatomical and physiological alterations that complicate the conduct of anesthesia. The brain is one of the vital organs of the body, and physiological changes during pregnancy alter the anesthesia management if associated with brain pathology. Malignant brain tumors and trauma remain a leading cause of indirect maternal mortality. Review of literature revealed paucity of evidence-based neuroanesthesia management for such patients. Navigating these uncharted waters remains a challenging exercise. With the lack of guidelines, the management is based largely on few case reports or case series.
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Krutko AV, Sanginov AJ, Peleganchuk AV, Alshevskaya AA, Moskalev AV, Byvaltsev VA. SURGICAL TREATMENT OF LUMBAR DISC HERNIATION IN PREGNANT WOMEN: REPORT OF TWO CASES AND A SYSTEMATIC REVIEW. COLUNA/COLUMNA 2018. [DOI: 10.1590/s1808-185120181703193835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
ABSTRACT Objective: To review the surgical treatment of lumbar disc herniation in pregnancy. Methods: We systematically reviewed cases of surgical treatment of pregnant patients with lumbar IVD herniations in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. We searched on electronic databases, including PubMed, Scopus, and Google Scholar, to find relevant articles by keywords. Results: A literature review of 42 cases is presented. Conclusions: The authors’ own data and the literature data demonstrate that decompression surgery in pregnancy is effective and safe for both mother and fetus; however, radical surgery (fusion) can lead to very adverse sequelae for the fetus. Level of Evidence III; Systematic reviewb of Level III studies.
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Fujii K, Orisaka M, Yamamoto M, Nishijima K, Yoshida Y. Primary intramedullary spinal cord tumour in pregnancy: a case report. Spinal Cord Ser Cases 2018; 4:25. [PMID: 29581892 DOI: 10.1038/s41394-018-0059-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 02/19/2018] [Accepted: 02/19/2018] [Indexed: 11/09/2022] Open
Abstract
Introduction Primary spinal cord tumours can lead to severe neurological complications and even death. Pregnant women often complain of discomfort of the lower limbs, which is usually caused by sciatica. Here we present the case of a pregnant woman, who was initially considered to have sciatica, but was finally diagnosed with a primary intramedullary spinal cord tumour. Case presentation A 28-year-old pregnant woman presented to our hospital with inexplicable numbness in her lower limbs. She was initially considered to have sciatica, but acute deterioration of neurological symptoms and plain magnetic resonance imaging (MRI) findings suggested malignancy. The patient was finally diagnosed with a primary intramedullary spinal cord tumour at the C3-Th5 region. An emergency caesarean section was performed, after which the spinal cord lesion was evaluated using contrast-enhanced MRI, positron emission tomography with 2-deoxy-2-[fluorine-18] fluoro-d-glucose integrated with computed tomography, and spinal angiography, and further treatment was initiated. However, while the patient's spinal cord tumour surgery was performed in early postpartum, her paraplegia and bladder and rectal disturbances remained unchanged even 1 year after surgery. Discussion Because of the low incidence of spinal cord tumours during pregnancy, no definite reports have been published on the treatment of pregnant patients with spinal cord tumours. Although safe imaging tests during pregnancy are limited, intervention in such patients should be performed as early as possible to avoid irreversible neurological deterioration.
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Affiliation(s)
- Kyoko Fujii
- Department of Obstetrics and Gynecology, University of Fukui, 23-3 Matsuoka-shimoaizuki, Eiheiji-cho, Yoshida-Gun Fukui, 910-1193 Japan
| | - Makoto Orisaka
- Department of Obstetrics and Gynecology, University of Fukui, 23-3 Matsuoka-shimoaizuki, Eiheiji-cho, Yoshida-Gun Fukui, 910-1193 Japan
| | - Makoto Yamamoto
- Department of Obstetrics and Gynecology, University of Fukui, 23-3 Matsuoka-shimoaizuki, Eiheiji-cho, Yoshida-Gun Fukui, 910-1193 Japan
| | - Koji Nishijima
- Department of Obstetrics and Gynecology, University of Fukui, 23-3 Matsuoka-shimoaizuki, Eiheiji-cho, Yoshida-Gun Fukui, 910-1193 Japan
| | - Yoshio Yoshida
- Department of Obstetrics and Gynecology, University of Fukui, 23-3 Matsuoka-shimoaizuki, Eiheiji-cho, Yoshida-Gun Fukui, 910-1193 Japan
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Liu TJ, Shen F, Zhang C, Huang PT, Zhu YJ. Real-time ultrasound-MRI fusion image virtual navigation for locating intraspinal tumour in a pregnant woman. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:436-439. [PMID: 29380148 DOI: 10.1007/s00586-017-5442-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 12/18/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Standard fluoroscopic guidance (C-arm fluoroscopy) has been routinely used for intraoperative localization of spinal level for surgical removal of intraspinal tumour, while it is not suitable for selected patients, e.g. pregnant women, who need to avoid radiation exposure. Fusion imaging of real-time ultrasound (US) and magnetic resonance imaging (MRI) is a radiation-free technique which has been reported to have good localization accuracy in managing several conditions. CLINICAL PRESENTATION A 37-year-old pregnant patient, presented with a progressively aggravating lower back pain for 20 days and was incapable of lying supine with lower extremities swelling for 1 week, was referred to our hospital in her 18th week of gestation. Lumbar MRI identified an L1 level intraspinal lesion, and surgery was planned. To avoid the ionizing radiation generated by fluoroscopy, volume navigation technique (VNT) based fusion imaging of US and MRI was used to localize the intraspinal lesion, which was removed entirely via minimally invasive interlaminar approach. Pathological examination confirmed the diagnosis of ependymoma of the conus medullaris. Her symptoms were largely relieved after the operation, and a healthy baby was delivered at the 40th week of pregnancy. CONCLUSION We presented the first case of using VNT based fusion imaging of real-time US/MRI to guide the surgical resection of an intraspinal tumour. Future study with larger patient number is needed to validate this technique as an alternative to fluoroscopy in patients who need to avoid radiation exposure.
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Affiliation(s)
- Tian-Jian Liu
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China
| | - Fang Shen
- Department of Orthopaedic Surgery's Spine Division, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
| | - Chao Zhang
- Ultrasound Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Pin-Tong Huang
- Ultrasound Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yong-Jian Zhu
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China.
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How to treat lumbar disc herniation in pregnancy? A systematic review on current standards. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:496-504. [PMID: 28429143 DOI: 10.1007/s00586-017-5040-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 03/07/2017] [Accepted: 03/09/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE In this systematic review, we aim to illustrate the current and safe concepts in the assessment, diagnosis and management of herniated lumbar disc (HLD) during pregnancy. METHODS A systematic review and reporting on the diagnosis, treatment and clinical results of HLD during pregnancy is performed. RESULTS The MRI represents the first level and safest diagnostic tool for pregnant women affected by spinal problems allowing for a noninvasive and detailed radiological examination of the spine. The initial management of pregnant women affected by HLD is conservative, and primarily aimed to pain therapy. Whenever radicular pain and progressive neurological deficits unresponsive to medical management occur, surgery should be considered. Few case reports regarding the operative management of HLD in pregnant women have been published up to date. Laminectomy and/or microdiscectomy represent the classical and most commonly used techniques that can be safely performed without affecting pregnancy, delivery, or baby's health. Endoscopic discectomy may be an alternative. The most adequate timing and surgical position are chosen based on to the fetal gestational age and site of the pathology. CONCLUSIONS Surgical treatments during pregnancy impose multiple medical and ethical problems. Timely diagnosis by MRI, careful clinical evaluation, and surgical treatment represent safe and effective procedures. Ongoing evolution of surgical, anesthesiological and obstetrical procedures results in favorable outcomes. However, interdisciplinary management and a wide knowledge of pregnancy-related pathologies are crucial for the best outcome for both mother and child.
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Bian C, Chen N, Li XL, Zhou XG, Lin H, Jiang LB, Liu WM, Chen Q, Dong J. Surgery Combined with Radiotherapy to Treat Spinal Tumors: A Review of Published Reports. Orthop Surg 2017; 8:97-104. [PMID: 27384717 DOI: 10.1111/os.12230] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 02/07/2016] [Indexed: 12/11/2022] Open
Abstract
Spinal tumors result in high morbidity and a high rate of lower limb paralysis. Both surgical therapy and radiation therapy (RT) are used to treat spinal tumors; however, how best to combine these two therapies to maximize the benefits and minimize the risks is still being debated. It is also difficult to decide the optimal timing, course and dose of RT, especially in pregnant women and children. The aim of this review is to assist surgeons who are dealing with spinal tumors by providing comprehensive information about advanced techniques for administering RT with greater precision and safety, and about the impact of various ways of combining surgery and RT on therapeutic outcomes. We here review published reports about treating spinal tumors with a combination of these two forms of therapy and attempt to draw appropriate conclusions concerning selection of optimal treatment protocols. Our conclusion is that postoperative radiotherapy, especially with high-precision, low-dose and multiple fractions, and brachytherapy are promising therapies to combined with surgery.
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Affiliation(s)
- Chong Bian
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Nong Chen
- Department of Orthopaedic Surgery, Zhongshan Hospital Qingpu Branch, Fudan University, Shanghai, China
| | - Xi-Lei Li
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiao-Gang Zhou
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hong Lin
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Li-Bo Jiang
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wang-Mi Liu
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qian Chen
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian Dong
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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Martynova MA, Konovalov NA, Lubnin AY, Shmigel'skiy AV, Savin IA, Tabasaranskiy TF, Akhvlediani KN, Sinbukhova EV, Onoprienko RA. [Spinal stroke in a pregnant female with an endodermal cyst of the cervical spinal cord (a case report and literature review)]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2017; 80:74-81. [PMID: 28139576 DOI: 10.17116/neiro201680674-81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM The study purpose was to present a clinical case of spinal stroke in a pregnant female, which was caused by an endodermal cyst of the cervical spinal cord, and to analyze treatment tactics. RESULTS A 20 week pregnant female presented with acute transverse spinal cord injury at the of C3-C5 spinal segment level. CT revealed an extramedullary space-occupying lesion in the ventrolateral position, with compression of the spinal cord at this level. The patient in the state of progressive deterioration with respiratory failure was transferred to the Neurosurgical Institute on the 5th day after disease onset. The patient underwent surgery on the 7th day after disease onset. Doctors of various specialties participated in preparation for surgery. During surgery, total resection of the space-occupying lesion and spinal cord decompression were performed. An obstetrician-gynecologist conducted intraoperative fetal monitoring by ultrasound. The histological diagnosis was an endodermal cyst. There was no improvement of neurological symptoms in the early postoperative period. After stabilization of the condition, the patient was discharged for follow-up care at the place of residence. According to the follow-up report, the patient underwent the cesarean section because of exacerbation of lung infection and a significant delay in the fetal development. After a few days, the patient died due to multiple organ failure. The child was alive, in serious condition, under mechanical ventilation. CONCLUSION In the case of spinal stroke, the decision on treatment tactics should be made no later than 12 hours after its onset; otherwise, the outcome is usually unfavorable, and a neurological deficit is irreversible. The decision about continuing pregnancy should be made individually in each case, and an approach to the choice of appropriate treatment tactics should be multi-disciplinary.
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Affiliation(s)
| | | | - A Yu Lubnin
- burdenko Neurosurgical Institute, Moscow, Russia
| | | | - I A Savin
- burdenko Neurosurgical Institute, Moscow, Russia
| | | | - K N Akhvlediani
- moscow Regional Research Institute of obstetriics and Gynecology, Moscow, Russia
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Surgical Management of the Pregnant Patient With Lumbar Disc Herniation in the Latter Stage of the Second Trimester. Spine (Phila Pa 1976) 2017; 42:E186-E189. [PMID: 27310022 DOI: 10.1097/brs.0000000000001741] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report. OBJECTIVE To report on a pregnant woman successfully treated with microendoscopic discectomy in the left lateral position under general anesthesia at 24-week gestation. SUMMARY OF BACKGROUND DATA Treatment for lumbar disc herniation in pregnant women poses a particular challenge due to the complexity of the clinical situation. Review of the literature emphasizes timely diagnosis with adequate management specific for each gestational period. A surgical approach mandates consideration of the physiologic parameters of pregnancy and the effects of these stressors on the fetus. METHODS A 38-year-old primigravid woman presented with persistent and incapacitating low back and left leg pain. Magnetic resonance imaging demonstrated a herniated disc at L4-5 with a severely compressed left L5 nerve root. Symptoms were resistant to conservative treatment (acetaminophen; 1200 mg/day) and nerve root block with corticosteroids (1 mg/0.5 mL of betamethasone plus 0.5 mL of 1% lidocaine) provided only transient pain relief. Operative management with surgical discectomy was discussed. Anesthesiologists, obstetricians, and neonatologists were consulted for preoperative planning, focusing on appropriate anesthesia, ideal positioning for surgical access, and provision for emergent fetal care. Surgery was ultimately performed in the left lateral position, in contrast to the oft-used prone position. Microendoscopic discectomy was performed under general anesthesia at 24-week gestation. RESULTS The patient experienced complete relief from pain after surgical intervention and delivered a healthy baby at 39-week gestation after normal labor. Our methods, used in accordance with our preoperative simulation, resulted in a satisfactory outcome for both mother and child. CONCLUSION Although previously published cases noted the safety of operating in the prone position under epidural anesthesia, we performed minimally invasive microendoscopic discectomy in the left lateral position in combination with general anesthesia and found that this is a safe and preferable alternative for pregnant patients in the latter stage of the second trimester. LEVEL OF EVIDENCE N/A.
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Jones CS, Patel S, Griffiths-Jones W, Stokes OM. Presentation of cauda equina syndrome during labour. BMJ Case Rep 2015; 2015:bcr-2015-212119. [PMID: 26581703 DOI: 10.1136/bcr-2015-212119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Lumbar disc herniations are rare in pregnancy, with an incidence of 1:10,000. Less than 2% of these herniations result in cauda equina syndrome (CES). Diagnosing CES in pregnant patients can be difficult because changes in bladder and bowel habits are common in normal pregnancies. We present the case of a 29-year-old woman, with a history of lumbar radiculopathy, who presented at 39 weeks gestation with severe lower back and bilateral lower limb radiculopathy. Symptoms of CES began to develop only after the onset of labour. Diagnostic MRI was obtained following delivery and the patient was treated by microdiscectomy. Following surgery, bladder and bowel function began to normalise and at 3 months follow-up, she had made a full recovery. To the best of our knowledge, CES has never been reported to present during labour. This case highlights the diagnostic dilemma and need for a high index of suspicion.
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Affiliation(s)
- Conor Stephen Jones
- Peninsula College of Medicine and Dentistry, Exeter, Devon, UK Exeter Spine Unit, Exeter, Devon, UK
| | - Salil Patel
- Peninsula College of Medicine and Dentistry, Exeter, Devon, UK Exeter Spine Unit, Exeter, Devon, UK
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26
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Vandse R, Cook M, Bergese S. Case Report: Perioperative management of a pregnant poly trauma patient for spine fixation surgery. F1000Res 2015; 4:171. [PMID: 26309729 PMCID: PMC4536612 DOI: 10.12688/f1000research.6659.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2015] [Indexed: 12/04/2022] Open
Abstract
Trauma is estimated to complicate approximately one in twelve pregnancies, and is currently a leading non-obstetric cause of maternal death. Pregnant trauma patients requiring non-obstetric surgery pose a number of challenges for anesthesiologists. Here we present the successful perioperative management of a pregnant trauma patient with multiple injuries including occult pneumothorax who underwent T9 to L1 fusion in prone position, and address the pertinent perioperative anesthetic considerations and management.
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Affiliation(s)
- Rashmi Vandse
- Department of Anesthesiology, Wexner Medical Center, Ohio State University, Columbus, Ohio, 43210, USA
| | - Meghan Cook
- Department of Anesthesiology, Wexner Medical Center, Ohio State University, Columbus, Ohio, 43210, USA
| | - Sergio Bergese
- Department of Anesthesiology, Wexner Medical Center, Ohio State University, Columbus, Ohio, 43210, USA
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Antepartum surgical management of Pott’s paraplegia along with maintenance of pregnancy during second trimester. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25:1064-9. [DOI: 10.1007/s00586-015-4045-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 05/17/2015] [Accepted: 05/21/2015] [Indexed: 11/24/2022]
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Kanas M, Kunzle H, Martins DE, Kirsch LA, Puertas EB, Wajchenberg M. Diskectomy during Pregnancy: Case Report and Review of the Literature. Global Spine J 2015; 5:130-4. [PMID: 25844286 PMCID: PMC4369201 DOI: 10.1055/s-0034-1387178] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 06/03/2014] [Indexed: 11/28/2022] Open
Abstract
Study Design Case report. Objective The purpose of this report is to discuss the management of a disk herniation during pregnancy and the indication and particularities of surgery in this situation. Methods We describe a case of diskectomy performed in a 35-year-old woman at 18 weeks of gestation. After 4 weeks of trying to manage the disk herniation with rest and medications without success, the muscle strength of the L5 right root decreased to grade 4, and the patient was not responding to intravenous analgesia. After discussion with the patient and family, a decision was made to perform the diskectomy. Results After surgery, the patient's pain lessened, and the Lasegue test became negative. Two weeks after the procedure, the patient's muscle strength was normal. In the 40th week of pregnancy, the patient gave birth without any complications. Conclusion When necessary, diskectomy can be indicated and performed during pregnancy. However, appropriate precautions must be taken. Awareness of these precautions is important for the success of the procedure and for the well-being of the mother and the newborn.
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Affiliation(s)
- Michel Kanas
- Spine Group from Department of Orthopedics and Traumatology, Universidade Federal de Sao Paulo (Unifesp), Sao Paulo, Brazil,Address for correspondence Michel Kanas, MD Al. Joaquim Eugênio de Lima1656, ap. 141, Jardim PaulistaSão Paulo–SP, Brazil, CEP 01403-002
| | - Hugo Kunzle
- Spine Group from Department of Orthopedics and Traumatology, Universidade Federal de Sao Paulo (Unifesp), Sao Paulo, Brazil
| | - Delio E. Martins
- Spine Group from Department of Orthopedics and Traumatology, Universidade Federal de Sao Paulo (Unifesp), Sao Paulo, Brazil
| | - Luiz A. Kirsch
- Department of Anesthesia, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Eduardo B. Puertas
- Spine Group from Department of Orthopedics and Traumatology, Universidade Federal de Sao Paulo (Unifesp), Sao Paulo, Brazil
| | - Marcelo Wajchenberg
- Spine Group from Department of Orthopedics and Traumatology, Universidade Federal de Sao Paulo (Unifesp), Sao Paulo, Brazil
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Therapeutic strategy and outcome of spine tumors in pregnancy: a report of 21 cases and literature review. Spine (Phila Pa 1976) 2015; 40:E146-53. [PMID: 25423305 DOI: 10.1097/brs.0000000000000719] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study was performed. OBJECTIVE To illustrate the characteristics of spine tumors during pregnancy and obtain better insight into therapeutic strategies of such tumors by analyzing 21 cases treated in Changzheng Hospital and reviewing previous reports in the literature. SUMMARY OF BACKGROUND DATA The concurrence of spine tumors and pregnancy is relatively rare. There are controversies over the treatment options for this disease, which increase the difficulty of the clinical treatment. METHODS Between 2002 and 2013, 21 pregnant patients were identified with spine tumors. Clinical data including symptoms, signs, treatment options, and obstetrical and neonatal outcomes were recorded and preserved. Clinical data and treatment efficacy were analyzed via medical record review. RESULTS The median age of the 21 patients was 28.87 years (interquartile range, 6.00 yr). Tumor types in this series were giant cell tumor (5 cases), hemangioma (5 cases), schwannoma (4 cases), eosinophilic granuloma (2 cases), neurofibroma (1 case), multiple myeloma (1 case), and with metastatic tumor (3 cases). Two patients underwent spine surgery during pregnancy and 8 patients accepted tumor resection immediately after delivery. Pregnancy termination occurred in 5 patients, whereas the rest of the patients smoothly gave birth to healthy babies including 3 premature infants. Two patients died and 2 patients experienced local recurrence during follow-up. CONCLUSION With close observation, it was found that most of pregnant patients with benign spine tumors could postpone surgery after delivery. Surgical treatment should be adopted during pregnancy when patients are with highly malignant tumor or experience a sharp deterioration and the guard of it is safer than radiotherapy and chemotherapy during pregnancy. LEVEL OF EVIDENCE 4.
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Banczerowski P, Czigléczki G, Papp Z, Veres R, Rappaport HZ, Vajda J. Minimally invasive spine surgery: systematic review. Neurosurg Rev 2014; 38:11-26; discussion 26. [DOI: 10.1007/s10143-014-0565-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 04/10/2014] [Accepted: 05/18/2014] [Indexed: 12/19/2022]
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Speirs E, Wiles M, Bacon A, Radley S. Positioning a proned patient with cauda equina syndrome who presents at 15 weeks gestation: a case report. F1000Res 2014; 3:117. [PMID: 25110580 PMCID: PMC4111115 DOI: 10.12688/f1000research.3310.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2014] [Indexed: 11/30/2022] Open
Abstract
Cauda equina syndrome is a neurosurgical emergency that requires prompt intervention to prevent irreversible spinal cord paralysis. This article describes how we managed a case of an obese pregnant patient who was placed in the prone position for surgery. We discuss the evidence behind the management options and choice of operating tables available.
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Affiliation(s)
- Elizabeth Speirs
- Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, S10 2JF, UK
| | - Matthew Wiles
- Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, S10 2JF, UK
| | - Andrew Bacon
- Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, S10 2JF, UK
| | - Stephen Radley
- Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, S10 2JF, UK
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Terry AR, Barker FG, Leffert L, Bateman BT, Souter I, Plotkin SR. Outcomes of hospitalization in pregnant women with CNS neoplasms: a population-based study. Neuro Oncol 2012; 14:768-76. [PMID: 22513749 PMCID: PMC3367848 DOI: 10.1093/neuonc/nos078] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 02/23/2012] [Indexed: 11/12/2022] Open
Abstract
Managing a CNS neoplasm during pregnancy presents complex challenges, and population-based studies are lacking. We designed a retrospective cohort study using the Nationwide Inpatient Sample (NIS) to investigate pregnancy outcomes in women with CNS neoplasms. We constructed a logistic regression model for maternal mortality, preterm labor, intrauterine growth restriction (IUGR), and Caesarean delivery, controlling for age, comorbidities, and demographic characteristics. We identified 379 malignant brain tumors, 437 benign brain tumors, and 44 spine tumors among 19 million pregnancy-related admissions from 1988 through 2009. Malignant brain tumors were associated with maternal mortality (odds ratio [OR], 143), preterm labor (OR, 3.4), and IUGR (OR, 2.9). Benign brain tumors were associated with preterm labor (OR, 2.3). A diagnosis of hyperemesis gravidarum was more common in malignant (OR, 2.2) and benign (OR, 2.8) brain tumors. Compared with the general population, Caesarean delivery was more frequent for malignant (OR, 6.4) and benign (OR, 2.8) brain tumors and spine tumors (OR, 3.9). Admission without delivery was more common for malignant (OR, 8.6) and benign (OR, 4.3) brain tumors and spine tumors (OR, 3.8; P < .05 for all outcomes). Thirty-three percent of all hospitalizations involved neurosurgical procedures, but pregnancy complications were not significantly more likely to occur in surgical patients. In conclusion, malignant brain tumors were associated with adverse pregnancy outcomes, and CNS neoplasms were associated with higher rates of Caesarean delivery. Additional research is needed to improve understanding of obstetric risk in these patients and to assist with treatment, counseling, and monitoring during delivery.
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Affiliation(s)
- Anna R Terry
- Neurosurgical Service, White 502, Massachusetts General Hospital, Boston, MA 02114, USA.
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Lee JM, Han IH, Moon SH, Choi BK. Surgery for Recurrent Lumbar Disc Herniation During Pregnancy: A Case Report. KOREAN JOURNAL OF SPINE 2011; 8:304-6. [PMID: 26064151 PMCID: PMC4461745 DOI: 10.14245/kjs.2011.8.4.304] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 12/27/2011] [Accepted: 01/05/2012] [Indexed: 11/19/2022]
Abstract
A few cases of lumbar disc herniation (LDH) that have been treated by surgery during pregnancy have been reported in the literature. However, symptomatic recurrent LDH during pregnancy has been rarely reported. A 32-year-old parous woman presented with lumbago and severe right leg pain at 20 weeks' gestation. Eleven years prior to admission, she had undergone an open discectomy for right-sided LDH at the L4-5 level. Magnetic resonance imaging (MRI) showed a recurrent disc herniation that affected the nerve root at the right L4-5 level. The radiating pain did not respond to conservative treat-ment. Revision surgery was performed under general anesthesia and in the left lateral position to avoid fetal stress and aortocaval compression, and the ruptured disc particle was completely removed. Postoperatively, the radiating pain was completely relieved. She delivered a full-term healthy girl (birth weight, 3.39 kg) at 40 weeks' gestation by normal vaginal delivery. We report the rare case of a 32-year-old parous woman with recurrent LDH that was successfully treated by revision surgery. In recurrent LDH patients with incapacitating pain who do not respond to opioid injections, surgical treat-ment could lead to a satisfactory outcome maintaining pregnancy.
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Affiliation(s)
- Jae Meen Lee
- Department of Neurosurgery, Pusan National University School of Medicine, Busan, Korea
| | - In Ho Han
- Department of Neurosurgery, Pusan National University School of Medicine, Busan, Korea
| | - Soo Hyeon Moon
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan, Korea
| | - Byung Kwan Choi
- Department of Neurosurgery, Pusan National University School of Medicine, Busan, Korea
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Brookfield KF, Brown MD. How should pregnant women with spinal disease be managed? NATURE CLINICAL PRACTICE. NEUROLOGY 2008; 4:652-653. [PMID: 19043422 DOI: 10.1038/ncpneuro0952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Accepted: 10/16/2008] [Indexed: 05/27/2023]
Abstract
This Practice Point commentary discusses a retrospective case series by Han et al. that investigated the management of spinal disease during pregnancy. On the basis of their experiences with 10 patients, Han et al. concluded that pregnant women who have progressive neurological deficit at 34-36 weeks' gestation or later should undergo induction of delivery or cesarean section before, or at the same time as, they undergo spinal surgery. As expressed by Han et al., MRI is the safest imaging modality with which to diagnose spinal disorders in pregnancy; however, it is our opinion that single exposure to any source of radiation from diagnostic imaging is unlikely to justify advising the pregnant patient to undergo therapeutic abortion. Spinal surgery has successfully relieved neurological symptoms in pregnant patients with spinal disorders and been followed by a successful delivery in a number of circumstances. In order to provide the optimum care for the pregnant woman and the fetus, however, a health-care team involving the spine surgeon, the obstetrician, and the anesthesiologist is necessary.
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Affiliation(s)
- Kathleen F Brookfield
- Department of Orthopaedics, Leonard M Miller School of Medicine, University of Miami, Miami, FL 33101, USA.
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