Spinal Cord Compression Following Labor and Delivery With Epidural Analgesia

Simon, Jena; Mokriski, Bettylou K.; Gillies, Bruce S.; Martz, Douglas; Keene, C. L.; Malinow, Andrew M.

doi:10.1097/00132582-199004000-00058

Cited by 2 publications

(3 citation statements)

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“…Epidural analgesia has been thought to be a risk factor but prospective studies have demonstrated that except for the first day(s), no differences can be found later on as compared with patients not receiving a neuraxial block 38,39 . This and gynaecological positional changes of the uterus and adnexes may be a more plausible explanation for back pain after delivery than the anaesthetic technique 40 . In addition, delivery itself may cause neural damage with ensuing persistent pain 41 .…”

Section: Back Pain and Disc Herniation In Pregnancymentioning

confidence: 99%

“…Not infrequently, the obstetrician opts for a caesarean section in these patients. At the present time, more than 10 cases have been reported with cauda equina symptomatology due to posterior disc displacement, necessitating urgent surgery 40,42–44 . This may be performed in the prone or the lateral position.…”

Section: Back Pain and Disc Herniation In Pregnancymentioning

confidence: 99%

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Neuraxial techniques in patients with pre‐existing back impairment or prior spine interventions: a topical review with special reference to obstetrics

Vercauteren

Waets

Pitkänen

et al. 2011

Acta Anaesthesiol Scand

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Many anaesthetists consider neurological disorders of all kinds as a contraindication for regional anaesthesia particularly for neuraxial techniques. This hesitation is partly rooted in fears of medicolegal problems but also in the heterogeneous literature. Therefore, the present topical review is an attempt to describe the feasibility and the risks of neuraxial techniques in patients with spinal injury, anatomical compromise, chronic back pain or previous spinal interventions, ranging from 'minor' types like epidural blood patches to major surgery such as Harrington fusions. Most reviews and case reports were describing experiences in obstetrics as these patients are more likely to insist on neuraxial blocks. In the acute phase of new neurologic injury, general anaesthesia may be the technique of choice to prevent further haemodynamic and respiratory deterioration. After the acute phase, current evidence is mostly reassuring with respect to the risks of neuraxial blocks as they may even be recommendable in some conditions. Ultrasound technology may be of additional help to increase the success rate. A careful pre-operative examination remains mandatory, while patients should be sufficiently informed about technical aspects and possible relapses or progression of their disease. When necessary, patients should have additional technical and clinical examinations as close as possible to surgery to establish the actual pre-operative status. Most patients may benefit more from spinal techniques rather than from less reliable epidural ones. High concentrations and volumes of local anaesthetics should be avoided at all times, especially in patients with nerve compression, large disc herniation or spinal stenosis.

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Section: Back Pain and Disc Herniation In Pregnancymentioning

confidence: 99%

Section: Back Pain and Disc Herniation In Pregnancymentioning

confidence: 99%

Neuraxial techniques in patients with pre‐existing back impairment or prior spine interventions: a topical review with special reference to obstetrics

Vercauteren

Waets

Pitkänen

et al. 2011

Acta Anaesthesiol Scand

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“…Reactivation of earlier disc diseases with spinal procedures is reported to be rare [ 17 , 18 ]. In our patient, a large disc protrusion far from the catheter level without any additional pathology has been demonstrated on MRI.…”

Section: Discussionmentioning

confidence: 99%

Thoracic disc herniation causing transient paraplegia coincident with epidural anesthesia: a case report

Kaya

Özgöçmen

2009

Cases J

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Neurological deficits following epidural or spinal anesthesia are extremely rare. Transient paraplegia following epidural anesthesia in a patient with thoracic disc herniation has been presented. A 44-year-old woman developed paraplegia during the operation for vascular surgery of her legs under epidural anesthesia. Epidural hematoma or spinal cord ischemia was ruled out by magnetic resonance imaging of the thoracic and lumbar spine in which protruded disc at T11-12 level compressing the spinal cord has been verified. Patient responded well to steroid treatment and rehabilitation interventions. Physicians should be aware of preceding disc protrusions, which may have detrimental effects on spinal cord perfusion, as a cause of persistent or transient paraplegia before epidural anesthesia procedure. MRI is a valuable imaging option to rule out epidural anesthesia complications and coexisting pathologies like disc herniations.

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Spinal Cord Compression Following Labor and Delivery With Epidural Analgesia

Cited by 2 publications

References 0 publications

Neuraxial techniques in patients with pre‐existing back impairment or prior spine interventions: a topical review with special reference to obstetrics

Neuraxial techniques in patients with pre‐existing back impairment or prior spine interventions: a topical review with special reference to obstetrics

Thoracic disc herniation causing transient paraplegia coincident with epidural anesthesia: a case report

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