Cauda equina syndrome in the third trimester

This pregnant woman (34 weeks’ gestation) in her late 40s presented with a one week history of lower back pain, bilateral sciatica, saddle anaesthesia, and urinary incontinence (fig 1). Magnetic resonance imaging of the spine showed disc extrusion at L4-5 with cauda equina compression along the line-of-sight of the fetus. The results of preoperative cardiotocography were normal. The patient underwent emergency laminectomy and discectomy of L4-5.bmj;385/apr11_3/e078711/F1F1f1Fig 1Delay in surgical decompression of cauda equina syndrome can result in permanent neurological deficits. The need for intraoperative use of fluoroscopic lumbar radiography to determine the correct level for surgery had to be balanced against the potential harms of exposing the fetus to radiation. As fetal radiation dose of <50 milligrays (mGy) is not associated with an increase in fetal anomalies, the <10 mGy dose from radiography was considered safe.12 The patient also had to be positioned prone to protect the gravid uterus and... Read Original Article: Cauda equina syndrome in the third trimester »