Presentation of cauda equina syndrome during labour

Abstract

Lumbar disc herniations are rare in pregnancy, with an incidence of 1:10,000. Less than 2% of these herniations result in cauda equina syndrome (CES). Diagnosing CES in pregnant patients can be difficult because changes in bladder and bowel habits are common in normal pregnancies. We present the case of a 29-year-old woman, with a history of lumbar radiculopathy, who presented at 39 weeks gestation with severe lower back and bilateral lower limb radiculopathy. Symptoms of CES began to develop only after the onset of labour. Diagnostic MRI was obtained following delivery and the patient was treated by microdiscectomy. Following surgery, bladder and bowel function began to normalise and at 3 months follow-up, she had made a full recovery. To the best of our knowledge, CES has never been reported to present during labour. This case highlights the diagnostic dilemma and need for a high index of suspicion.

The Management of Symptomatic Lumbar Disc Herniation in Pregnancy: A Systematic Review

“…22,28 The prone position is not recommended beyond 12 weeks of gestation 22,35 without the use of a Relton-Hall laminectomy frame as it can cause abdominal compression, inciting preterm labour. 21,[36][37][38] A left lateral position is preferable for patients in later stages of the second trimester and the third, 28 providing superior surgical exposure while avoiding aortocaval compression. 17,22,29,33,39 Pregnancy is not a contraindication for general or regional anaesthesia.…”

Surgical Treatment of Lumbar Disc Herniation in Pregnant Women: Report of Two Cases and a Systematic Review

“…The characteristics of all the identified patients are shown below Table 1. [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] The median age of the females was 32.8 (IQR, 30−36) years. At least, twenty-three (50%) females had a history of at least one pregnancy.…”