Egu Chinedu, Akintunde Samuel, Adekoya Motunrayo, Essiet Edidiong, Komaitis Spyridon, Najjar Elie
Centre for Spinal Studies and Surgery, Queens Medical Centre, Nottingham University Hospitals National Health Service (NHS) Trust, Nottingham, GBR.
Cureus. 2024 Jun 30;16(6):e63550. doi: 10.7759/cureus.63550. eCollection 2024 Jun.
Cauda equina during pregnancy represents a rare entity, with data regarding optimal treatment being very scarce in the pertinent literature. Given the scarcity of current evidence on the topic, this study conducts a systematic review and analysis of existing literature concerning cauda equina syndrome (CES) management in pregnant women. A comprehensive search was performed across multiple databases, yielding 26 level IV peer-reviewed articles that met the inclusion criteria. These studies collectively encompassed 30 pregnant patients with CES, with a mean age of 31.2 years and an average gestational age of 26 weeks. Disc herniation emerged as the primary cause in 73% of cases. Regarding surgical interventions, the prone position was utilised in 70% of cases, with 73% receiving general anaesthesia. Notably, third-trimester spinal surgeries exhibited a higher complete recovery rate compared to earlier trimesters. Minimally invasive spinal surgery demonstrated superior outcomes in terms of complete recovery and reduced risk of persistent post-operative symptoms when compared to open approaches. Moreover, patients undergoing caesarean section (CS) after spinal surgery reported higher rates of symptom resolution and lower symptom persistence compared to those with CS before spinal surgery or vaginal delivery post-spinal surgery. Despite these study's findings, the overall evidence base remains limited, precluding definitive conclusions. Consequently, the study underscores the importance of multidisciplinary team discussions to formulate optimal treatment strategies for pregnant individuals presenting with CES. This highlights a critical need for further research to expand the knowledge base and improve the guidance available for managing CES in pregnant populations.
孕期马尾综合征是一种罕见的病症，相关文献中关于最佳治疗方法的数据非常稀少。鉴于目前该主题的证据匮乏，本研究对有关孕妇马尾综合征（CES）管理的现有文献进行了系统综述和分析。在多个数据库中进行了全面检索，筛选出26篇符合纳入标准的IV级同行评审文章。这些研究共纳入了30例患有CES的孕妇，平均年龄为31.2岁，平均孕周为26周。73%的病例中，椎间盘突出是主要病因。在手术干预方面，70%的病例采用俯卧位，73%的病例接受全身麻醉。值得注意的是，与孕早期相比，孕晚期脊柱手术的完全恢复率更高。与开放手术相比，微创脊柱手术在完全恢复和降低术后持续症状风险方面表现出更好的效果。此外，与脊柱手术前进行剖宫产（CS）或脊柱手术后经阴道分娩的患者相比，脊柱手术后进行CS的患者症状缓解率更高，症状持续时间更短。尽管有这些研究结果，但总体证据基础仍然有限，无法得出明确结论。因此，该研究强调了多学科团队讨论对于为患有CES的孕妇制定最佳治疗策略的重要性。这突出表明迫切需要进一步研究，以扩大知识库并改善针对孕妇CES管理的指导。
