Medical and surgical management of acute spinal injury during pregnancy: A case series in a third-world country
- Department of Neurosurgery, Juha Hernesniemi International Neurosurgery Center, Henan Provincial People's Hospital, 7 Weiwu Road, Zhengzhou, China
- Department of Neurosurgery, AL-Thawrah General Model Hospital, Sana’a, Yemen
- Department of Neurosurgery, Nobel Institute of Neuroscience, Nobel Medical College Teaching Hospital, Biratnagar, Nepal
- Division of Neurosurgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Neurosurgery, Hospital Joan XXIII, Tarragona, Spain
- Department of Neurosurgery, International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Division of Physical Medicine & Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; G.F. Strong Rehabilitation Centre, Vancouver, British Columbia, Canada
Department of Neurosurgery, Juha Hernesniemi International Neurosurgery Center, Henan Provincial People's Hospital, 7 Weiwu Road, Zhengzhou, China
DOI:10.4103/sni.sni_380_18Copyright: © 2018 Surgical Neurology International This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
How to cite this article: Ajmal Zemmar, Ahmed Al-Jradi, Vincent Ye, Ismail Al-Kebsi, Hugo Andrade-Barazarte, Emal Zemmar, Josue Avecillas-Chasin, Iype Cherian, Andrei V. Krassioukov, Juha Hernesniemi. Medical and surgical management of acute spinal injury during pregnancy: A case series in a third-world country. 24-Dec-2018;9:258
How to cite this URL: Ajmal Zemmar, Ahmed Al-Jradi, Vincent Ye, Ismail Al-Kebsi, Hugo Andrade-Barazarte, Emal Zemmar, Josue Avecillas-Chasin, Iype Cherian, Andrei V. Krassioukov, Juha Hernesniemi. Medical and surgical management of acute spinal injury during pregnancy: A case series in a third-world country. 24-Dec-2018;9:258. Available from: http://surgicalneurologyint.com/surgicalint-articles/9148/
Background:There is scant literature describing the management of acute spinal injury in pregnant patients. Here, we report our experience with five cases of pregnant patients including three females who suffered acute traumatic spinal cord injuries (SCIs).
Methods:This retrospective study evaluated five pregnant women presenting with traumatic spinal injuries over a 16-month period. All were assessed using the International Standards for Neurological Classification of Spinal Cord Injury Patients and the American Spine Injury Association Impairment Scale (AIS).
Results:Three patients sustained SCIs: two cervical spine (C4 AIS-A and C5 AIS-B) and one thoracolumbar junction fracture dislocation (T11 AIS-A). Two patients required surgical stabilization during pregnancy, with one undergoing surgery after delivery. All three patients subsequently delivered healthy newborns. The remaining two patients without neurologic deficits at admission were treated conservatively; one had a healthy child, whereas the other patient aborted the baby due to the initial trauma.
Conclusions:Our study demonstrates that the same surgical principals may be applied to pregnant women as to routine patients with SCIs. Further studies with greater patient data should be performed to better develop significant guidelines for the management of pregnant patients with spinal injuries.
Keywords: Autonomic dysreflexia, management, pregnancy, spinal cord injury
Trauma during pregnancy is the leading nonobstetrical cause of maternal death, affecting up to 8% of all pregnancies.[
From 2016 to 2017, we evaluated five pregnant women who sustained spinal trauma (Al-Thawra Model General Hospital, Sana’a-Yemen). Patient data were retrospectively assessed and included patient age, gestational age, Gravida, mechanism of injury, location of injury, American Spine Injury Association (ASIA) Impairment Scale (AIS),[
Out of 392 patients with traumatic spinal injury, 19.6% were females of childbearing age (15–40 years) [
This series of five cases involving pregnant patients comprises three spinal cord-injured females with neurological deficits requiring surgery and two neurologically intact patients managed conservatively. The surgical procedures included an anterior C5 corpectomy and C4–6 fixation, an anterior C7 corpectomy and C6–T1 fixation [
There are few reports on the management of traumatic spinal injuries during pregnancy.[
Impact of positioning in pregnant females for spine surgery
Notably, utilizing the prone position for spine surgery is feasible during the first part of the second trimester but is contraindicated after 12 weeks of gestation.[
Management of acute SCI during pregnancy
The management of acute SCI during pregnancy is not well documented in the literature. In a case series of five patients, three were treated surgically and two conservatively with similar outcomes to our study with the exception of one baby dying shortly after delivery, whereas all other newborns were healthy.[
Timing of surgical intervention versus safety of pregnancy
All three spinal cord-injured patients in this series underwent surgical intervention. Various studies document improved neurological recovery with early surgery.[
Complications occurring in these five pregnant patients with SCI included urinary tract infections, sacral pressure ulcers, and deep venous thrombosis, whereas low birth weight was the only complication among the newborns [
This study demonstrates that successful surgical stabilization and good obstetrical outcomes were achieved in three pregnant patients with SCI who were managed operatively. Multifaceted treatment options and close monitoring should be continued throughout their hospital stay. Further studies are necessary to evaluate the optimal timing of surgical versus nonsurgical management of these patients.
Financial support and sponsorship
This work was supported by grants from the EMDO foundation (872), the Heidi Demetriades Foundation and the ETH Zurich Foundation to AZ, the Canadian Foundation for Innovation, BC Knowledge Translation Foundation, the Canadian Institute for Health Research, the Craig Neilsen Foundation and the Heart and Stroke Foundation to AVK and by the Henan Provincial People's Hospital Outstanding Talents Funding Grant Project.
Conflicts of interest
There are no conflicts of interest.
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