Spinal Cord Disorders

doi:10.1017/9781009070256.016

Chapter 15 - Spinal Cord Disorders

Published online by Cambridge University Press: 26 January 2024

Roanne Preston and

Jonathan Collins

Edited by

David R. Gambling,

M. Joanne Douglas and

Grace Lim

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David R. Gambling: Affiliation:
University of California, San Diego
M. Joanne Douglas: Affiliation:
University of British Columbia, Vancouver
Grace Lim: Affiliation:
University of Pittsburgh

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Summary

Due to diagnostic, therapeutic, and rehabilitative advances, obstetric anesthesia providers are increasingly likely to encounter patients with disorders of the spinal cord. Sound knowledge of associated anatomic and physiologic abnormalities, coupled with an understanding of how the physiologic changes of pregnancy interact, are crucial to managing these increasingly complex patients. This chapter covers congenital and acquired spinal cord disorders, including acute and chronic spinal cord injury, spinal dysraphism, spinal cord tumors and vascular malformations, syringomyelia, the anterior spinal artery syndrome, infectious diseases and neurodegenerative conditions. Multidisciplinary management, with the team ideally being convened prior to conception, is crucial. For the most part, parturients with spinal cord disorders can attempt vaginal delivery. Operative delivery is usually reserved for obstetric reasons, for patients who would be unlikely to tolerate labor due to cardiopulmonary comorbidity, or for patients whose spinal cord pathology mandates delivery prior to, or synchronous with, definitive management. While spinal cord disorders do not necessarily preclude neuraxial anesthesia per se, providers are urged to obtain recent neuroimaging, and to document a preanesthetic neurological examination. The presence of surgical metalwork or implanted devices may pose challenges requiring an individualized approach.

Keywords

spinal cord injury spina bifida open dysraphism closed dysraphism tethered cord anterior spinal artery syndrome transverse myelitis neurodegenerative disorder schistosomiasis Zika virus

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Type: Chapter
Information: Obstetric Anesthesia and Uncommon Disorders , pp. 231 - 258
DOI: https://doi.org/10.1017/9781009070256.016 [Opens in a new window]
Publisher: Cambridge University Press
Print publication year: 2024

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