Department of Anesthesia, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Women's College Hospital, ON, Canada.
Can J Anaesth. 2011 Aug;58(8):764-8. doi: 10.1007/s12630-011-9525-3. Epub 2011 May 28.
To illustrate the successful management of a patient with post-traumatic syringomyelia (PTS) and chronic pain syndrome who presented for elective Cesarean delivery under epidural anesthesia.
A 30-yr-old gravida 3 para 1 woman, with a known diagnosis of cervical PTS secondary to a whiplash injury sustained three years earlier, presented to the labour and delivery unit at 31 weeks' gestation. She had severe pain in the cervical and lumbar spine, motor and sensory deficits in the upper extremities, tender mass in her left trapezius muscle, and history of dizziness and syncopal episodes. She was taking oxycodone 120 mg·day(-1) Magnetic resonance imaging of her spine revealed a syrinx of 2 mm in diameter extending from C4 to T1 levels with disc protrusions in the C4-C6 region. There was no evidence of Arnold-Chiari malformation or elevated intracranial pressure. On airway examination, her Mallampati score appeared normal, but there was a limitation in the range of her neck movements in all directions. An elective Cesarean delivery was planned at 39 weeks' gestation. An epidural catheter was placed using ultrasound guidance, and the procedure was performed without complications.
The successful management of this case suggests that epidural can be considered in women with cervical PTS presenting for a Cesarean delivery.
介绍一例创伤后脊髓空洞症（PTS）伴慢性疼痛综合征患者的成功治疗案例，该患者在硬膜外麻醉下择期行剖宫产术。
一名 30 岁的初产妇，G3P1，3 年前因挥鞭样损伤导致颈椎 PTS，此次妊娠 31 周时因慢性疼痛就诊于产房。她的颈椎和腰椎有严重疼痛，上肢运动和感觉功能受损，左侧斜方肌有触痛性肿块，并有头晕和晕厥病史。她每天服用 120 毫克羟考酮。脊柱磁共振成像显示颈 4 至胸 1 水平直径 2 毫米的脊髓空洞症，颈 4-6 区域有椎间盘突出。无 Arnold-Chiari 畸形或颅内压升高的证据。气道检查时，Mallampati 评分正常，但颈部活动范围各向均受限。计划在 39 周妊娠时行择期剖宫产术。使用超声引导下置入硬膜外导管，操作过程无并发症。
本例成功治疗提示，对于因剖宫产而就诊的颈椎 PTS 妇女，可考虑使用硬膜外麻醉。
