Spina bifida occulta and epidural anaesthesia

McGrady, Elizabeth; Davis, Atara

doi:10.1111/j.1365-2044.1988.tb05602.x

Cited by 24 publications

(4 citation statements)

References 2 publications

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“…However, spinal cord injury is possible without MRI imaging confirmation if tethered cord syndrome is present [ 15 ]. Indeed, spinal cord injuries due to neuraxial anesthesia in pregnant women with undiagnosed latent spina bifida and tethered cord syndrome have been reported [ 16 , 17 ]. Therefore, in pregnant women suspected of having spina bifida, confirmation of the location of the conus medullaris by MRI is essential to prevent nerve injury, and analgesic methods other than neuraxial anesthesia should be considered if the risk of spinal cord injury is high.…”

Section: Discussionmentioning

confidence: 99%

Anesthesia outcomes of pregnant women with spinal diseases: a single-center case-series study

Yakhup,

Okada,

Kawagoe

et al. 2023

JA Clin Rep

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Background Neuraxial anesthesia is widely used as the most effective and standard method in obstetric anesthesia. However, there is a concern that neuraxial anesthesia may be technically difficult or ineffective in pregnant women with spinal disease. Therefore, this study aimed to investigate the implementation rate of neuraxial anesthesia among pregnant women with spinal diseases and their success rate at our institution. Methods The subjects of this study were pregnant patients who delivered at Juntendo University Nerima Hospital between April 2017 and December 2020. After obtaining ethics committee approval, data were collected from patients’ medical records. Results Of the 2682 pregnant women who delivered, 1550 underwent preanesthetic evaluation. There were 42 deliveries in 39 pregnant women with spinal diseases (1.7% of all pregnant women and 2.7% of those who underwent preanesthetic evaluation). The diagnoses included adolescent idiopathic scoliosis (51.3%), lumbar disc herniation (23.1%), and others. The mode of delivery was the elective cesarean section in 5 cases, emergent cesarean section in 8 cases, and vaginal delivery in 29 cases. Only one case required general anesthesia. Of the 38 cases of labor analgesia, the neuraxial block was inadequate in 3 cases (7.9%) and technically difficult in 3 cases (7.9%). However, the patients complained of no lower extremity neuropathy, infection, or inadvertent dural puncture. Discussion Neuraxial anesthesia was an option in most cases, even in pregnant women complicated with spinal disease, if an anesthesiologist’s plan before delivery after careful preanesthetic evaluation.

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Section: Discussionmentioning

confidence: 99%

Anesthesia outcomes of pregnant women with spinal diseases: a single-center case-series study

Yakhup,

Okada,

Kawagoe

et al. 2023

JA Clin Rep

View full text Add to dashboard Cite

show abstract

“…It is also reported that a parturient with undiagnosed spina bifida who underwent an emergent CS under spinal anesthesia developed foot drop immediately after surgery and MRI imaging revealed a low-lying cord with a fatty filum terminale and intramedullary, suggestive of needle damage [ 12 ]. Considering these previous reports [ 13 , 14 ], general anesthesia might be preferable to neuraxial anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonographic images of spina bifida before obstetric anesthesia: a case series

et al. 2023

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Background Spina bifida is a relatively common congenital malformation. As the functional prognosis of patients with spina bifida has improved over time, the number of cases resulting in pregnancy and delivery has increased. Lumbar ultrasonography has become a standard and helpful technique before neuraxial anesthesia. We believe that it might be valuable if we use lumbar ultrasonography to evaluate pregnant women with spina bifida before obstetric anesthesia. Case presentation We performed lumbar ultrasonography to evaluate four pregnant women with spina bifida. Patient 1 had no history of surgery. Lumbar radiography before pregnancy showed a bone defect from L5 to the sacrum as a result of incomplete fusion. Magnetic resonance imaging showed a spinal lipoma and a bone defect of the sacrum. Lumbar ultrasonography showed similar findings. We performed general anesthesia for emergency cesarean delivery. Patient 2 underwent surgical repair immediately after birth. Lumbar ultrasonography showed the same bone defect as well as a lipoma beyond the bone defect. We performed general anesthesia for cesarean delivery. Patient 3 had vesicorectal disorders but no prior surgery. Lumbar radiography before pregnancy showed congenital abnormalities such as incomplete fusion, scoliosis, rotation, and a notably small sacrum. Lumbar ultrasonography showed the same bone defect. We performed general anesthesia for cesarean section with no complications. Patient 4 complained of lumbago a few years after her first delivery and received a diagnosis of spina bifida occulta by lumbar radiography, with the incomplete fusion of only the 5th vertebra. Lumbar ultrasonography indicated the same abnormalities. We placed an epidural catheter to avoid the bone abnormality and achieved epidural labor analgesia with no complications. Conclusions Lumbar ultrasonography shows anatomic structures easily, safely, and consistently, without X-ray exposure or the need for more expensive modalities. It is a helpful technique to explore anatomic structures potentially complicated by spina bifida before anesthetic procedures.

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“…Regardless, the presence of a dimple with a deep sinus tract would deter most anesthesiologists from performing a caudal block. While there are multiple case reports of neurologic complications from lumbar spinal and epidural blocks in patients with spina bifida occulta, because of a tethered or low-lying spinal cord (2)(3)(4), the literature is sparse when it comes to caudal blocks. The general belief is that caudals should be avoided in children with sacral dimples because of the increased possibility of a wet tap (1); this claim, as far as we can tell, is not evidence based.…”

Section: Discussionmentioning

confidence: 99%

“…While the defect may be an isolated finding, it might signal an underlying spinal abnormality. Spina bifida occulta is a common disorder of the spine, and complications from neuraxial anesthesia have been reported (2)(3)(4). These have involved spinal and epidural blocks, but there is little written about this condition and caudal blocks.…”

mentioning

confidence: 99%