Mit seit Jahren zunehmendem Alter der Mutter bei der Geburt ihres ersten Kindes steigt
die Anzahl der schwangeren Patientinnen mit Wirbelsäulenpathologien. Nach wie vor
bestehen hier weit verbreitet Unklarheiten bezüglich Möglichkeiten der Diagnostik,
der operativen und konservativen Therapie sowie zum klinischen Verlauf der Schwangerschaft
nach spinalen Eingriffen. Dieser Beitrag zeigt, welche präoperative Diagnostik und
wie spinale OP-Techniken bedenkenlos angewendet werden dürfen.
Abstract
The increasing age of pregnant patients has led to a rise in spinal pathologies during
pregnancy, necessitating specific considerations for their management. We present
a treatment algorithm encompassing preoperative diagnostics, intraoperative care –
including anesthesia, fluoroscopy, patient positioning, and monitoring – and postoperative
pain management. Spinal MRI remains the diagnostic gold standard. From the 12th week
of pregnancy, left lateral positioning helps reduce aortocaval compression. The use
of fluoroscopy must balance diagnostic benefits against radiation risks. Preoperative
antibiotics, such as cefuroxime, are deemed safe. Ultrasound evaluations and, from
the 24th week onward, CTG monitoring of the fetus are recommended. Paracetamol and
opioids are preferred for pain management, while NSAIDs should be avoided in late
pregnancy. Necessary surgery should not be delayed, and elective procedures can be
deferred until postpartum based on individual risk assessments. Conclusion: Spinal
interventions in pregnant patients are safe when proper anesthesia, fluoroscopy, and
monitoring are employed.
Schlüsselwörter
Schwangerschaft - Wirbelsäulenchirurgie - Bandscheibenvorfall
Keywords
pregnancy - spinal surgery - herniated disc
