Endoscopic Discectomy for the Cauda Equina Syndrome During Third Trimester of Pregnancy

Kim, Hyeun Sung; Kim, Seok Won; Lee, Seung Myung; Shin, Ho Seong

doi:10.3340/jkns.2007.42.5.419

Cited by 43 publications

(42 citation statements)

References 9 publications

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“…Endoscopic discectomy precludes the need for general anaesthesia as the patient is positioned in comparison with the microscope. The prone self-position avoids excessive abdominal compression, and this illustrates the current safe approach to patients with lumbar disc herniation in pregnancy 95 96…”

Section: Other Orthopaedic Complications In Pregnancymentioning

confidence: 93%

Musculoskeletal symptoms and orthopaedic complications in pregnancy: pathophysiology, diagnostic approaches and modern management

Bhardwaj

Nagandla

2014

Postgraduate Medical Journal

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Low back pain is a common musculoskeletal symptom in pregnancy that can present as lumbar pain or pelvic girdle pain, with significant physical and psychosocial implications. Pelvic girdle pain is more prevalent and results in greater disability than lumbar pain. It is possible to distinguish between these two conditions from a detailed history based on the site of the pain, its intensity, disability and pain provocation tests. Management of low back pain in pregnancy is conservative, with physical exercise for lumbar pain and minimising activities that exacerbate pain, analgesics and bed rest for pelvic girdle pain, as well as avoiding abduction beyond the pain-free zone in labour. There is evidence that stabilising exercises in patients with pelvic girdle pain postpartum have a beneficial effect. Other treatment modalities that have been shown to be safe and effective include pelvic belts, transcutaneous electrical nerve stimulation, spinal manipulative therapy, acupuncture and complementary therapy with yoga. Other orthopaedic complications in pregnancy such as carpal tunnel syndrome, pubic symphysis rupture, transient osteoporosis and osteonecrosis are usually self-limiting with a satisfactory outcome. However, a lack of awareness and failure to recognise these complications can result in long-term morbidity. Knowledge of the preoperative diagnostic investigations, surgical approaches and intraoperative positioning of the mother to avoid gravid uterus compression is vital in orthopaedic emergencies such as lumbar disc herniation, cauda equina syndrome, fractures and acute compartment syndrome of the lower limb to ensure a safe maternal and fetal outcome and to prevent serious disability. Pregnancy is not contraindicated in women with pre-existing orthopaedic complications such as kyphoscoliosis and total hip arthroplasty as there is no evidence to suggest increased maternal or fetal risks.

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Section: Other Orthopaedic Complications In Pregnancymentioning

confidence: 93%

Musculoskeletal symptoms and orthopaedic complications in pregnancy: pathophysiology, diagnostic approaches and modern management

Bhardwaj

Nagandla

2014

Postgraduate Medical Journal

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“…et al reported a rare case of CES caused by LDH during the third trimester of pregnancy, which was successfully treated by PELD[11]. Subash et al presented a X. Li and Q. Dou are co-first authors.…”

mentioning

confidence: 94%

Treatment of cauda equina syndrome caused by lumbar disc herniation with percutaneous endoscopic lumbar discectomy

Dou

Zhou

et al. 2015

Acta Neurol Belg

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To evaluate the feasibility and clinical efficacy of percutaneous endoscopic lumbar discectomy (PELD) for cauda equina syndrome (CES) caused by disc herniation. 16 patients with CES caused by LDH at the early and middle stages of Shi's classification were selected as the objects of study, who underwent PELD. Clinical outcomes were assessed using the Macnab criteria and the visual analogue scale (VAS). The VAS for leg pain and back pain significantly decreased from preoperative scores of 7.67 ± 1.23 and 7.52 ± 1.42, respectively, to postoperative scores of 1.71 ± 0.53 and 3.18 ± 0.72. Thirteen patients showed favorable results. Complications included one patient of motor weakness, and one patient developed an ipsilateral recurrent herniation who finally acquired satisfactory result after reoperation. Hence, PELD could be used as an alternative surgical method for the treatment of CES in properly selected cases and appropriate patient selection and a reasonable surgical approach will give rise to better outcomes.

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“…Eight case reports and 2 case series described surgical interventions for intervertebral disc herniation causing neurological deficits (sensory, motor, bladder, or bowel involvement) including discectomy (open [38,39,41] , micro-discectomy [18,42] , or endoscopic [45] ), laminectomy [46] , or both [40,43,44] ( Table 2 d). Three case reports [47,48,50] and one literature review [91] described surgical management of vertebral fractures and vertebral hemangiomas respectively.…”

Section: Surgical Interventionsmentioning

confidence: 99%

“…Most common pathologies diagnosed on imaging in pregnancy include intervertebral disc herniations, vertebral hemangiomas and fractures and sacral stress fractures. MRI is the most commonly used imaging modality for pregnant women with neurological compromise (dermatomal lower limb numbness [38] , perineal numbness [39,40] , lower limb weakness [18,39,40,43,45,46] , or loss of bladder/bowel control [40,43,45] ). Suspected disc herniation was the most frequent reason for imaging, followed by incapacitating LBP without neurological compromise [42] .…”

Section: Diagnostic Investigationsmentioning

confidence: 99%

See 1 more Smart Citation

Low Back Pain in Pregnancy: Investigations, Management, and Role of Neuraxial Analgesia and Anaesthesia: A Systematic Review

Sehmbi

D’Souza

Bhatia

2017

Gynecol Obstet Invest

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Background: Low back pain (LBP) is commonly experienced during pregnancy and is often poorly managed. There is much ambiguity in diagnostic work-up, appropriate management and decision-making regarding the use of neuraxial analgesia and anaesthesia during labour and delivery in these patients. This systematic review summarises the evidence regarding investigations, management strategies and considerations around performing neuraxial blocks for pregnant women with LBP. Methods: We searched 3 databases and reviewed literature concerning LBP in pregnancy with regards to diagnostic modalities, management strategies and use of neuraxial techniques for facilitating labour and delivery. Results: In all, we included 78 studies in this review, with 32 studies concerning diagnostic investigations, 56 studies involving management strategies, and 4 studies regarding the use of neuraxial techniques for labour and delivery. Summary: MRI is the safest investigative modality for LBP in pregnancy. Antenatal educational programmes, exercise and steroid injections into the epidural space or sacroiliac joints may help with pain management. Worsening neurological deficits, vertebral fractures and tumours may need surgical management. There is limited evidence on challenges of performing neuraxial blocks in the peripartum period for analgesia and anaesthesia, but there is a potential for increased risk of neurological complications in parturients with pre-existing neurological deficits.

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Endoscopic Discectomy for the Cauda Equina Syndrome During Third Trimester of Pregnancy

Cited by 43 publications

References 9 publications

Musculoskeletal symptoms and orthopaedic complications in pregnancy: pathophysiology, diagnostic approaches and modern management

Musculoskeletal symptoms and orthopaedic complications in pregnancy: pathophysiology, diagnostic approaches and modern management

Treatment of cauda equina syndrome caused by lumbar disc herniation with percutaneous endoscopic lumbar discectomy

Low Back Pain in Pregnancy: Investigations, Management, and Role of Neuraxial Analgesia and Anaesthesia: A Systematic Review

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