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Anesthesia

Expectant Mother with Spine Injury

09/01/2009

Question:

Hi, I am 37 yrs old and pregnant with my first child. I have 4 cervical disc that have been herniated for many years. After consulting doctors we have opted for surgery, after the child is born. I also have L4, L5, and herniations and SI joint pain along with 2 previous coccyx fractures that left me with constant pain in that area. My question is, can I request a C section to avoid/prevent further injury to my spine and prevent additional injury or herniations to additional discs? Can an epidural be given above L4/L5? I am very scared of being further injured and having to care for a baby.

Answer:

An epidural can be given above the level of the 4th lumbar vertebra ("L4"). In fact an epidural can be administered at any level in the spine, even in the cervical spine (neck). (But don't try this at home. An epidural in the neck requires special skill and is usually done with x-ray imaging). Of course an epidural involves insertion of a needle into areas where nerve structures exist so there is a small risk of nerve injury associated with epidural and spinal anesthesia. These injuries almost always recover fully. There is almost no risk of injury to spinal disks of the kind you have mentioned and in fact epidurals are sometimes used to treat the pain of spinal disc herniation.

You should ask for a discussion with your anesthesiologist to allay your fears, and to have a proper evaluation of your issues and come up with the best plan for anesthesia and analgesia for your delivery.

The issue of whether a C-Section can prevent further injury to your spine is something I am not really qualified to address. Nerve injuries around the time of labor - primarily during the passage of the baby's head through the birth canal - do occur not uncommonly. Maternal exertion and straining during delivery might also be associated with problems in those with existing disc herniation. Avoiding this phase of labor should therefore prevent these problems but I've not sure that studies have looked at this - you should ask your obstetrician.

Good luck with the delivery and I hope everything goes beautifully.

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Response by:

Gareth S Kantor, MD Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University