Medical and surgical management of acute spinal injury during pregnancy: A case series in a third-world country

Abstract

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.

Figure 1

(a) Preoperative MRI scan from case 2 demonstrating a C6/C7 fracture dislocation. (b) Postoperative imaging demonstrating adequate alignment and placement of the anterior plate

Figure 2

(a) Preoperative MRI from case 3 showing a T12 fracture dislocation with severe compression of the spinal cord. (b) A postoperative image demonstrating the posterior instrumented fusion