Background and Aims Spinal dysraphism is a heterogeneous group of vertebral arches disorders with direct implications for the peripartum anaesthetic care. In fact, even if labour analgesia is a common regional anaesthetic technique to provide pain relief during labour, the presence of spinal dysraphism generally contraindicates the use of neuraxial approaches.
Methods We present the case of a 30-year-old female, ASA 2, who presented to our department at 38 weeks of gestation for pre-operative evaluation. During the clinical evaluation, a skin dimple was noted in the sacral area and no visible scoliosis was identified. An accurate neurological examination was completely negative without any related symptoms. A lumbar magnetic resonance imaging (MRI) revealed a tethered cord syndrome with an interrupted sacral posterior neural arch located at S2 and associated with an abnormally low positioned conus medullaris (figure 1).
Results Epidural analgesia was selected to avoid a possible spinal cord injury using combined spinal-epidural technique. Consequently, an epidural catheter was inserted at L2-L3 level and 10mcg epidural sufentanyl bolus followed by intermittent top-up 15-20ml ropivacaine 0.1-0.2% injections allowed an optimal pain management during the labour. No complications and adverse effects occurred in the postpartum period.
Conclusions This case suggests that a proper evaluation of spinal dysraphism is a key element to improve the labour’s anaesthetic management and for determining the feasibility of neuraxial analgesia. In fact, labour analgesia can be safely performed in well selected patients with tethered cord syndrome.
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