Spinal emergency surgery during pregnancy: contemporary strategies and outcome.

Abstract Background Low back pain is a common complaint during pregnancy. However, spinal pathologies, which manifest with severe pain, radiculopathy and acute neurological deficits due to disc herniation or mass lesions require special attention. Here, we present our interdisciplinary experience in the surgical management of spinal emergencies during pregnancy. Materials and 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 work-up, signs and symptoms of mothers, and diagnostic procedures were evaluated. After an interdisciplinary conference individualized treatment plans with regard to 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 disc herniations manifesting as severe sciatica or foot drop and three patients with 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 three women prior to the neurosurgical procedure, while the pregnancies were maintained in the six other patients. Eight infants who were healthy at birth had an unremarkable development. Conclusion 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 the majority of patients.