Introduction

Cauda equina syndrome (CES) following lumbar disc herniation is exceedingly rare in pregnancy and there is limited literature outlining management of CES in pregnancy. There is further limited data addressing the management of periviable pregnancies complicated by CES.

Case presentation

A 38-year-old female at 22 weeks gestation presented with worsening lower back pain radiating to the right posterior lower extremity. She was initially managed with conservative therapy, but re-presented with worsening neurologic symptoms, including fasciculations and perineal numbness. Magnetic resonance imaging showed a large herniated disc at L4-5, and given concern for CES, she underwent emergent decompression surgery, which was complicated by a superficial wound dehiscence. She ultimately carried her pregnancy to term and had a cesarean delivery. The patient’s residual neurologic symptoms continued to improve with physical therapy throughout the postpartum period.

Discussion

Cauda equina syndrome is a rare spinal condition with potentially devastating outcomes if not managed promptly. Diagnosis and management of CES in pregnancy is the same as in non-pregnant patients, however, standardization of patient positioning for surgery, surgical approach, anesthetic use, and fetal considerations is lacking. A multidisciplinary approach is critical, especially at periviable gestational ages of pregnancy. Our case and review of the literature demonstrates that patients in the second trimester can be managed surgically with prone positioning, intermittent fetal monitoring, and continued management of the pregnancy remains unchanged. Given the rarity of these cases, there is a need for a consensus on management and continued care in pregnant patients with CES.

中文翻译：

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马尾综合征与围产期妊娠手术干预

介绍

腰椎间盘突出症后发生马尾综合征（CES）在妊娠期极其罕见，概述妊娠期 CES 治疗的文献也很有限。关于 CES 复杂化的围产期妊娠管理的数据进一步有限。

案例展示

一名 38 岁女性，妊娠 22 周时出现腰部疼痛恶化，并放射至右后下肢。她最初接受保守治疗，但再次出现神经系统症状恶化，包括肌束震颤和会阴麻木。磁共振成像显示 L4-5 处有一个大的椎间盘突出，考虑到 CES，她接受了紧急减压手术，但由于浅表伤口裂开而变得复杂。她最终足月怀孕并进行了剖腹产。在整个产后期间，通过物理治疗，患者的残余神经系统症状持续改善。

讨论

马尾综合症是一种罕见的脊柱疾病，如果不及时治疗，可能会造成毁灭性的后果。妊娠期 CES 的诊断和管理与非妊娠期患者相同，但缺乏手术患者体位、手术入路、麻醉剂使用和胎儿考虑的标准化。多学科的方法至关重要，尤其是在妊娠的围产期。我们的病例和文献综述表明，中期妊娠的患者可以通过俯卧位、间歇性胎儿监护和持续妊娠管理进行手术治疗。鉴于这些病例的罕见性，需要就 CES 妊娠患者的管理和持续护理达成共识。