engleski

Acute spinal cord injury (ASCI) during pregnancy with good outcome

Incidence of traumatic spinal cord injury is 11000 /year, 18 % of patients being women of reproductive age. We present a case of a patient in her 17th week of pregnancy who received a luxation fracture of C5/C6 vertebra and tetraplegia as consequence as a passenger in a road accident, with good outcome. The patient was primary treated in a surgical facility of secondary type, where radiology diagnostics was not preformed due to her pregnancy.The patient complained of shudder in her arms with movement preserved in all extremities. The patient was referred to an emergency gynecological assessment, where in transport she developed tetraplegia.She arrived at spinal injuries clinic 16 hours after the accident where upon NMR of cervical spine she was submitted to an emergency procedure of disc extirpation and anterior spondylodesis. The patient was assessed ASA IIIE.Following the spinal injuries protocol methilprednizolon was administered and invasive hemodynamic monitoring was set . During the surgical procedure and due to the hemodynamic instability (spinal shock) low dosage of noradrenalin was administered with volume replacement.The patient stably bore the procedure and was extubated 2 hours postoperatively. Extremities movement recovered 10 hours postoperatively.The patient was verticalised with help of physiotherapist 48 hours after the procedure. Early spinal decompression with MAP 85-90mmHg in order to improve spinal cord perfusion along with iatrogenic steroid methilprednizolon, as well as high progesterone level in pregnancy as neuroprotecive, promyelination and anti-inflammatory effect of steroids in ASCI have a leading place in neurological recovery and clinical outcome

Acute spinal cord injury; Pregnancy

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