Neuraxial anesthesia in obstetric patients with rare spinal pathologies: a scoping review

Neuraxial anesthesia remains the primary approach for obstetric patients, emphasizing the need for a successful blockade. However, many anesthetists view spinal pathologies as contraindications for regional anesthesia. The existing literature on the use of neuraxial anesthesia in obstetric patients with rare spinal pathologies is largely limited to case reports and case series. The goal of this investigation is to evaluate the success rates and complications associated with neuraxial anesthesia in these obstetric patients.

We searched the databases: PubMed, Embase, Scopus, and Web of Science for cohort studies, case-control studies, case-series, and case reports available in English published between 2012 and 2024. Pathologies with a prevalence greater than 50 per 100,000 were excluded.

Our review yielded 51 publications reporting on 121 total cases. There were 33 vaginal deliveries and 88 cesarean deliveries, including 68 successful neuraxial procedures, 46 primary general anesthesia procedures without prior neuraxial attempts, and seven unsuccessful attempts converted to general anesthesia. Pathologies with failed neuraxial procedures included Marfan Syndrome, Dwarfism, Klippel-Feil, and Currarino triad, mostly due to inadequate anesthesia/analgesia. Complications in successful neuraxial procedures included multiple attempts, multiple operators, high spinal block, local anesthetic resistance, and spinal cord injury (dural puncture).

Neuraxial anesthesia remains feasible for these obstetric patients with careful pre-procedural planning, individualized technique modifications, and imaging guidance. Anesthesiologists should be prepared for potential challenges and have contingency plans, including readiness for general anesthesia. Further research is needed to establish standardized guidelines for the management of these patients.