How should pregnant women with spinal disease be managed?

Abstract

This Practice Point commentary discusses a retrospective case series by Han et al. that investigated the management of spinal disease during pregnancy. On the basis of their experiences with 10 patients, Han et al. concluded that pregnant women who have progressive neurological deficit at 34-36 weeks' gestation or later should undergo induction of delivery or cesarean section before, or at the same time as, they undergo spinal surgery. As expressed by Han et al., MRI is the safest imaging modality with which to diagnose spinal disorders in pregnancy; however, it is our opinion that single exposure to any source of radiation from diagnostic imaging is unlikely to justify advising the pregnant patient to undergo therapeutic abortion. Spinal surgery has successfully relieved neurological symptoms in pregnant patients with spinal disorders and been followed by a successful delivery in a number of circumstances. In order to provide the optimum care for the pregnant woman and the fetus, however, a health-care team involving the spine surgeon, the obstetrician, and the anesthesiologist is necessary.