Positioning issues of spinal surgery during pregnancy

Abstract Background Albeit rarely, different spinal pathologies may require a 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 undergoingspine surgery. Methods We performed a systematic review of literature about the described surgical positioning strategies employed for spinal surgery during pregnancy, discussing advantages, indications and limits. We also describe of a novel ¾ 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 as well as the clinical condition of mother and fetus. During the second trimester the habitus begins to raise issues about both the abdominal and the aorto-caval compressions. The third trimester implies neonatal and ethical challenges: both fetal monitoring and the possibility to urgently proceed to delivery should be guaranteed. The prone position is feasible during the second trimester provided an adequate frame is supplied. The lateral or ¾ 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 materno-fetal safety should be balanced by a multidisciplinary team in order 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 ¾ positionings.