Positioning issues of spinal surgery during pregnancy

Area of Science:

• Neurosurgery
• Obstetrics
• Anesthesiology

Background:

• Spinal pathologies rarely necessitate surgery during pregnancy, presenting unique management challenges.
• Adequate patient positioning is a critical consideration for surgical safety in pregnant patients.

Purpose of the Study:

• To review surgical positioning strategies for pregnant women undergoing spinal surgery.
• To outline the indications and limitations of various positioning techniques.

Main Methods:

• Systematic literature review of described surgical positioning strategies for pregnant patients.
• Discussion of advantages, indications, and limitations of each method.
• Description of a novel three-quarters prone positioning for dorsal pathologies.

Main Results:

• Surgical positioning depends on pathology, gestational stage, and maternal-fetal condition.
• Second-trimester surgery allows prone positioning with adequate support; third-trimester poses challenges due to abdominal size and aortocaval compression.
• Lateral or three-quarters prone positioning is safest in late pregnancy; supine and sitting positions are rarely used.

Conclusions:

• A multidisciplinary team must balance gestational age, surgical needs, and maternofetal safety for optimal positioning.
• Early third-trimester positioning is most challenging due to uterine size, favoring lateral or three-quarters prone approaches.