Spine surgery in pregnant women: a multicenter case series and proposition of treatment algorithm

Vicki M Butenschoen,Silvia M Lobmaier,Enrico Tessitore,Nikolaus Kögl,Paul Constanthin,Martin Bretschneider,Claudius Thome,Jan S Kirschke,Maria Wostrack,Bernhard Meyer,Hanna Hitscherich,Sven O Eicker,Peter Vajkoczy,Judith Rösler

doi:10.1007/s00586-021-06726-2

Abstract

PurposeSpinal 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.MethodsThe 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.ResultsTwenty-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.ConclusionSpinal 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.

Highlights

Back pain is a common symptom of pregnancy and occurs in up to 56% of pregnant women [1]
The following parameters were captured for further evaluation: maternal age and gestational age at the time of the surgery, neurological symptoms before surgery and at discharge, perioperative surgery-related complications, pregnancy history based on gynecological monitoring, gynecological complications in the perioperative period, operative diagnosis, preoperative, intraoperative and postoperative imaging
Approval for the study was obtained from the Overall, 24 pregnant patients were assigned to spinal surgery, all of them with urgent indications

Summary

Introduction

Back pain is a common symptom of pregnancy and occurs in up to 56% of pregnant women [1]. Previous studies correlated lower lumbar spine pain and pelvic pain with increased levels of relaxin, a hormone produced primarily by the corpus luteum during pregnancy [2]. Surgery-requiring nerve root compression syndromes caused by herniated disks during pregnancy are less common and affect approximately 1 in 10,000 pregnant women [3]. Other spinal diseases, such as tumors, bony injuries. Extended author information available on the last page of the article and infections, are much more rarely encountered during pregnancy. Several diagnostic and therapeutic aspects are to consider, especially when a surgical approach during pregnancy is required: which drugs and diagnostic tests are safe to use, the indication for surgery, the optimum timing and technique for the procedure, appropriate anesthesia, perioperative pregnancy monitoring and when to follow-up

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