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Lumbar laminectomy and tumor resection in an 18 week parturient with Cauda Equina Syndrome for Recurrent Giant cell tumor of lumbar spine.
Abstract Number: F-77
Abstract Type: Case Report/Case Series
In general 1% - 2% of pregnant women undergo non-obstetric surgery; the most common surgeries are acute appendicitis, cholecystitis, maternal trauma and malignancy(1). But we present a rare complicated case of lumbar laminectomy and tumor resection in a 18 week parturient with Cauda equina syndrome in prone position
20 yr old morbidly obese parturient at 18 weeks of gestation was admitted for worsening severe back pain radiating to her lower extremities. She had a past medical history of giant cell tumor of the lumbar spine and cauda equina syndrome, s/p lumbar laminectomy and decompression few months prior to this admission. MRI on admission, showed recurrence of her lumbar tumor resulting in severe lumbar spinal compression at L4-L5 and L5-S1 level. Neurosurgery advised that she needed total resection of the lumbar tumor but preferred to delay the surgery due the complexity of the surgery during pregnancy.
However during the next few days, she had worsening severe back pain and also developed urinary incontinence. So surgery become imminent and OB recommended operating during this time as she was in her second trimester. Patient was counseled regarding the possible risk of threatened abortion during the procedure or immediately after, and she consented for the procedure. Fetal heart tones were monitored preoperatively and noted to be appropriate. She underwent Lumbar laminectomy, tumor resection at L5 and decompression under general anesthesia. For monitoring, patient had standard ASA monitors with an arterial line. She was positioned prone for the entire procedure and had approximately 1500ml of blood loss. She tolerated the procedure well and stable throughout the case; did not require blood transfusion. Fetal heart tones were monitored postoperatively and noted to be appropriate. Her U/S scan showed a viable fetus with good heart tones. Patient’s neurological deficits and symptoms considerably improved postoperatively. OB/GYN continued to follow her throughout the hospital course. She was discharged two weeks post operatively. She is currently 24 weeks of gestation and the fetus continues to do well without any complications.
According to literature, spine surgeries generally have good outcomes during pregnancy(1). Second trimester would be the best time to perform non obstetric surgeries on the parturient. Whenever feasible, regional anesthesia is preferred over general anesthesia during pregnancy. The key anesthetic considerations during complicated non obstetric surgeries like this case is to maintain adequate maternal oxygenation, perfusion and homeostasis to maintain adequate uteroplacental perfusion in order to bring out the best outcome both for the mother and the fetus.
1. Ardaillon H1, Laviv Y2, Arle JE2, Kasper EM3 Lumbar disk herniation during pregnancy: a review on general management and timing of surgery. Acta Neurochir (Wien). 2017 Jan 31