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Chapter 15 - Spinal Cord Disorders

Published online by Cambridge University Press:  26 January 2024

By
Roanne Preston  and
Jonathan Collins
Edited by
David R. Gambling ,
M. Joanne Douglas  and
Grace Lim
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 injuryspina bifidaopen dysraphismclosed dysraphismtethered cordanterior spinal artery syndrometransverse myelitisneurodegenerative disorderschistosomiasisZika virus
Type
Chapter
Information
Obstetric Anesthesia and Uncommon Disorders , pp. 231 - 258
Publisher: Cambridge University Press
Print publication year: 2024

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