Abstract
Introduction
Cauda equina syndrome (CES) following lumbar disc herniation is exceedingly rare in pregnancy and there is limited literature outlining management of CES in pregnancy. There is further limited data addressing the management of periviable pregnancies complicated by CES.
Case presentation
A 38-year-old female at 22 weeks gestation presented with worsening lower back pain radiating to the right posterior lower extremity. She was initially managed with conservative therapy, but re-presented with worsening neurologic symptoms, including fasciculations and perineal numbness. Magnetic resonance imaging showed a large herniated disc at L4-5, and given concern for CES, she underwent emergent decompression surgery, which was complicated by a superficial wound dehiscence. She ultimately carried her pregnancy to term and had a cesarean delivery. The patient’s residual neurologic symptoms continued to improve with physical therapy throughout the postpartum period.
Discussion
Cauda equina syndrome is a rare spinal condition with potentially devastating outcomes if not managed promptly. Diagnosis and management of CES in pregnancy is the same as in non-pregnant patients, however, standardization of patient positioning for surgery, surgical approach, anesthetic use, and fetal considerations is lacking. A multidisciplinary approach is critical, especially at periviable gestational ages of pregnancy. Our case and review of the literature demonstrates that patients in the second trimester can be managed surgically with prone positioning, intermittent fetal monitoring, and continued management of the pregnancy remains unchanged. Given the rarity of these cases, there is a need for a consensus on management and continued care in pregnant patients with CES.
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References
LaBan MM, Perrin JC, Latimer FR. Pregnancy and the herniated lumbar disc. Arch Phys Med Rehabil. 1983;64:319–21.
Todd NV. Cauda equina syndrome: is the current management of patients presenting to district general hospitals fit for purpose? A personal view based on a review of the literature and a medicolegal experience. Bone Joint J. 2015;97-B:1390–4.
Fraser S, Roberts L, Murphy E. Cauda equina syndrome: a literature review of its definition and clinical presentation. Arch Phys Med Rehabil. 2009;90:1964–8.
Kuris EO, McDonald CL, Palumbo MA, Daniels AH. Evaluation and management of cauda equina syndrome. Am J Med. 2021;134:1483–9.
Chau AMT, Xu LL, Pelzer NR, Gragnaniello C. Timing of surgical intervention in cauda equina syndrome: a systematic critical review. World Neurosurg. 2014;81:640–50.
McNamee J, Flynn P, O’Leary S, Love M, Kelly B. Imaging in cauda equina syndrome–a pictorial review. Ulster Med J. 2013;82:100–8.
Gitelman A, Hishmeh S, Morelli BN, Joseph SA, Casden A, Kuflik P, et al. Cauda equina syndrome: a comprehensive review. Am J Orthop (Belle Mead NJ). 2008;37:556–62.
Gleave JRW, Macfarlane R. Cauda equina syndrome: what is the relationship between timing of surgery and outcome? Br J Neurosurg. 2002;16:325–8.
Ardaillon H, Laviv Y, Arle JE, Kasper EM. Lumbar disk herniation during pregnancy: a review on general management and timing of surgery. Acta Neurochir (Wien). 2018;160:1361–70.
Nonobstetric Surgery During Pregnancy [Internet]. [cited 2023 Jul 24]. Available from: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/04/nonobstetric-surgery-during-pregnancy
LaBan MM, Rapp NS, von Oeyen P, Meerschaert JR. The lumbar herniated disk of pregnancy: a report of six cases identified by magnetic resonance imaging. Arch Phys Med Rehabil. 1995;76:476–9.
Garmel SH, Guzelian GA, D’Alton JG, D’Alton ME. Lumbar disk disease in pregnancy. Obstet Gynecol. 1997;89:821–2.
Berkmann S, Fandino J. Pregnancy and childbirth after microsurgery for lumbar disc herniation. Acta Neurochir (Wien). 2012;154:329–34.
Esmaeilzadeh M, Hong B, Polemikos M, Al-Afif S, Hermann EJ, Scheinichen D, et al. Spinal emergency surgery during pregnancy: contemporary strategies and outcome. World Neurosurg. 2020;139:e421–7.
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Winsten, M.T., Fine, J., Fahimuddin, F. et al. Cauda equina syndrome with surgical intervention in pregnancy during the periviable period. Spinal Cord Ser Cases 10, 35 (2024). https://doi.org/10.1038/s41394-024-00646-1
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DOI: https://doi.org/10.1038/s41394-024-00646-1