Brown M D, Levi A D
Departments of Orthopaedics and Rehabilitation and Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA.
Spine (Phila Pa 1976). 2001 Feb 15;26(4):440-3. doi: 10.1097/00007632-200102150-00022.
The case reports of three pregnant patients with lumbar disc herniation causing cauda equina syndrome or severe neurologic deficits are presented to illustrate that disc surgery during gestation is a safe method of management.
To emphasize the importance of recognizing and definitively treating lumbar disc displacement causing neurologic deficits during pregnancy.
The advent of magnetic resonance imaging and modern surgical techniques for treatment of lumbar disc displacement allows safe management of this condition at any stage of gestation. A review of the literature on the risks of nonobstetric surgery and the risks of delaying disc surgery until delivery shows that operating at any stage during gestation for severe neurologic deficit secondary to lumbar disc displacement is justified.
A review of the literature on the use of magnetic resonance imaging scan and nonobstetric surgery during pregnancy was performed. Three case reports of the authors' patients who had lumbar disc displacement with cauda equina syndrome or severe neurologic deficit are presented. Patients were placed prone on a four-poster frame, and an epidural anesthetic agent was administered. A one-level hemilaminectomy, partial facetectomy, and disc excision were performed in all three cases.
The methods used for diagnosis and surgical treatment of three patients with disc herniation during pregnancy resulted in a satisfactory outcome for both mother and child. The medical literature supports surgical intervention in pregnant patients with cauda equina syndrome and severe and/or progressive neurologic deficit(s) from lumbar disc displacement at any state of gestation.
Although extremely rare, cauda equina syndrome and severe and/or progressive neurologic deficit caused by lumbar disc displacement can occur during pregnancy. The prevalence of symptomatic lumbar disc herniation during pregnancy may be on the increase because of the increasing age of patients who are becoming pregnant. These cases showed, and the literature confirms, that pregnancy at any stage is no contraindication to magnetic resonance imaging scan, epidural and/or general anesthesia, and surgical disc excision.
本文报告了3例因腰椎间盘突出症导致马尾综合征或严重神经功能缺损的孕妇病例，以说明妊娠期椎间盘手术是一种安全的治疗方法。
强调认识并明确治疗妊娠期导致神经功能缺损的腰椎间盘移位的重要性。
磁共振成像和现代治疗腰椎间盘移位的手术技术的出现，使得在妊娠的任何阶段都能安全地处理这种情况。回顾关于非产科手术风险以及将椎间盘手术推迟至分娩的风险的文献表明，对于因腰椎间盘移位继发严重神经功能缺损而在妊娠期任何阶段进行手术是合理的。
对妊娠期使用磁共振成像扫描和非产科手术的文献进行了综述。本文报告了作者所治疗的3例患有腰椎间盘移位并伴有马尾综合征或严重神经功能缺损的患者病例。患者俯卧于四柱框架上，并给予硬膜外麻醉剂。所有3例均行单节段半椎板切除术、部分关节突切除术和椎间盘切除术。
用于诊断和手术治疗3例妊娠期椎间盘突出症患者的方法，对母婴均产生了满意的结果。医学文献支持对妊娠期任何阶段患有马尾综合征以及因腰椎间盘移位导致严重和/或进行性神经功能缺损的孕妇进行手术干预。
尽管极为罕见，但妊娠期可发生因腰椎间盘移位导致的马尾综合征以及严重和/或进行性神经功能缺损。由于孕妇年龄的增加，妊娠期有症状的腰椎间盘突出症的患病率可能在上升。这些病例表明且文献也证实，妊娠的任何阶段都不是磁共振成像扫描、硬膜外和/或全身麻醉以及手术椎间盘切除术的禁忌证。
