Emergent spinal pathologies in late-term pregnancy

Pregnancy-induced changes to spinal anatomy and physiology can increase the complexity of neurosurgical intervention in this population. There are numerous reports focused on the neurosurgical management of intracranial pathology for pregnant patients. However, less is known about the neurosurgical management of acute spinal pathology. This study aims to discuss the management of emergent spinal pathology during late-term pregnancy. This is a case series of acute spinal pathologies in pregnancy. Epidural spinal needle fracture, epidural abscess, disc herniation causing an acute neurological deficit, and potential spine trauma. An extensive literature search relevant to the operative cases was performed to highlight the relevant themes to management. (1) The epidural spinal needle fracture was managed by surgical exploration under local anesthesia. (2) The epidural abscess was managed with laminectomy and surgical evacuation of the infective mass under general anesthesia. (3) The acute disc herniation was managed with laminectomy and discectomy under general anesthesia. All three examples were managed with emergent surgeries with improvement of symptoms. (4) The potential spine trauma was managed nonoperatively. Relevant similar cases from the literature review were summarized and strategies for management were outlined. Several factors such as anesthesia type, positioning, and operation sequencing must be considered when managing acute spinal pathology in late-term pregnant patients, necessitating multi-disciplinary input. However, effective management can result in successful surgical intervention and improvement of symptoms.