PDF(Pubmed)
Abstract：
Cauda equina during pregnancy represents a rare entity, with data regarding optimal treatment being very scarce in the pertinent literature. Given the scarcity of current evidence on the topic, this study conducts a systematic review and analysis of existing literature concerning cauda equina syndrome (CES) management in pregnant women. A comprehensive search was performed across multiple databases, yielding 26 level IV peer-reviewed articles that met the inclusion criteria. These studies collectively encompassed 30 pregnant patients with CES, with a mean age of 31.2 years and an average gestational age of 26 weeks. Disc herniation emerged as the primary cause in 73% of cases. Regarding surgical interventions, the prone position was utilised in 70% of cases, with 73% receiving general anaesthesia. Notably, third-trimester spinal surgeries exhibited a higher complete recovery rate compared to earlier trimesters. Minimally invasive spinal surgery demonstrated superior outcomes in terms of complete recovery and reduced risk of persistent post-operative symptoms when compared to open approaches. Moreover, patients undergoing caesarean section (CS) after spinal surgery reported higher rates of symptom resolution and lower symptom persistence compared to those with CS before spinal surgery or vaginal delivery post-spinal surgery. Despite these study\'s findings, the overall evidence base remains limited, precluding definitive conclusions. Consequently, the study underscores the importance of multidisciplinary team discussions to formulate optimal treatment strategies for pregnant individuals presenting with CES. This highlights a critical need for further research to expand the knowledge base and improve the guidance available for managing CES in pregnant populations.
摘要：
怀孕期间的马尾是一种罕见的实体，有关最佳治疗的数据在相关文献中非常稀缺。鉴于目前有关该主题的证据很少，本研究对现有有关孕妇马尾综合征（CES）管理的文献进行了系统的回顾和分析。在多个数据库中进行了全面搜索，产生26篇符合纳入标准的IV级同行评审文章。这些研究共包括30名患有CES的孕妇，平均年龄31.2岁，平均胎龄26周。在73％的病例中，椎间盘突出是主要原因。关于手术干预，70%的病例使用了俯卧位，73%接受全身麻醉。值得注意的是,与妊娠早期相比，妊娠晚期脊柱手术的完全恢复率更高。与开放方法相比，微创脊柱手术在完全恢复和减少持续术后症状的风险方面表现出优异的效果。此外，与脊柱手术前或脊柱手术后阴道分娩的剖腹产患者相比,脊柱手术后接受剖腹产(CS)的患者报告的症状缓解率较高,症状持续率较低.尽管有这些研究发现,总体证据基础仍然有限，排除明确的结论。因此,该研究强调了多学科团队讨论对于为接受CES治疗的孕妇制定最佳治疗策略的重要性.这凸显了进一步研究的迫切需要，以扩大知识库并改进可用于管理怀孕人群CES的指导。
