Asian Spine J > Volume 16(2); 2022 > Article |
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Conflict of interest
No potential conflict of interest relevant to this article was reported.
Author Contributions
AA was responsible for designing the review protocol, conducting the search, screening potentially eligible studies, extracting and analyzing data, interpreting results, creating ‘summary of findings’ tables, and writing the report. HD was responsible for designing the review protocol and screening potentially eligible studies. He also contributed to data extraction and provided feedback on the report.
Study | Methodological quality | Country | Age (yr) / G & P | Cause of injury | GA (at the time of injury) | Skeletal injury | Neurological deficit / AIS grade | Spine management | Obstetric outcome | SCI-specific complications | FU |
---|---|---|---|---|---|---|---|---|---|---|---|
Tanchev et al. [17] (2000) | Low | Bulgaria | Case 1: 20 / NR | MVA | 7th lunar month | T12–L1 spinal fractures | No neurological deficit | Open reduction and posterior compression instrumentation along with posterior fusion with autografts from the iliac crest | A normal healthy baby was delivered through cesarean section. | NR | At an 18-month FU after the surgery no signs of neurologic compromise |
Bulgaria | Case 2: 19 / NR | MVA | 6th lunar month | T12–L1 spinal fractures | Neurologic signs in the form of paresthesias and numbness in the lower extremities | Open reduction and posterior stabilization along with posterior fusion with autografts from the iliac crest | Spontaneous abortion | NR | At a 12-month FU after the surgery no signs of neurologic compromise | ||
Gençosmanoğlu et al. [24] (2001) | Low | Turkey | 21 / G2P1 | GSW | 16th week | Fracture of the C4 and C5 vertebrae | C5 ASIA B | Spinal injury managed conservatively with Philadelphia collar | A normal healthy female baby was delivered through NVD. | Neuropathic bladder, constipation, anemia; severe lower limb spasticity at FU | At 13 months post-injury, the patient improved to ASIA D and she walked with crutches. |
Popov et al. [10] (2003) | Low | South Africa | 21 / primigravida | GSW | 36th week | C6–C7 vertebral bodies fracture | A left hemiplegia with decreased sensory perception on the right due to compression of the spinal cord by the oedema | Spinal injury managed conservatively with soft cervical collar | A normal healthy baby was delivered through cesarean section. | NR | Patient neurological status at FU is not reported. However, it was reported that the patient makes satisfactory progress to recovery during hospitalization. |
Malomo et al. [22] (2005) | Low | Nigeria | 25 / primigravida | MVA | 29th week | C4–C5 anterior subluxation and fracture of C4 spinous process | Incomplete C4 spinal cord injury; Frankel grade C | Spinal injury managed conservatively with Gardner Wells’ tongs traction | 2.3 kg female baby was delivered through vaginal delivery with the aid of episiotomy. | UTI, anemia | At 14 months post-injury, the patient was fully ambulant without any support. |
Nnamdi et al. [23] (2007) | Low | Nigeria | Case 1: 27 / G4P3 | Fall | 26th week | Anterior wedge compression fracture of C6, C7–T1 subluxation | It was reported that patient had sensation up to T4 level and had normal upper limb power & no lower limbs power but exact information related to neurological level was not reported. | Spinal injury managed conservatively with skull traction | A normal healthy female baby was delivered through NVD. | UTI, PU, pneumonia, anemia | At a 3-month FU after delivery, the baby was normal while the mother remained a paraplegic rehabilitated on a wheelchair. |
Nigeria | Case 2: 35 / G5P4 | MVA | 28th week | C5–C6 unstable fracture | Frankel scale A | Spinal injury managed conservatively with cervical collar | A premature baby of 1.2 kg was delivered 3 days after the injury but the mother herself died shortly after the delivery. | Headache, blurring of vision, blood pressure 160 / 100 mm Hg (AD), death of the patient | At a 3-week FU, the baby weighed 1.65 kg and at a 3-month FU, the baby weighed 5 kg and was doing well. | ||
Lenarz et al. [6] (2009) | Moderate | USA | 39 / G2P1 | Fall | 17th week | Burst fracture of 12th thoracic vertebral body | It was reported that patient experienced lower extremity weakness and bowel & bladder incontinence but exact information related to neurological level was not reported. | Vertebral body corpectomy and spinal canal decompression | A normal healthy baby was delivered through cesarean section. | NR | At a 5-month FU after delivery, the patient was able to walk without assistive devices. Her bowel and bladder were continent. |
Schnake et al. [21] (2011) | Moderate | Germany | 24 / NR | MVA | 19th week | Wedged compression fracture of T5 and complete burst fracture of T8 | No neurological deficit | Anterior, thoracoscopic-assisted reduction, and stabilization | A normal healthy baby was delivered. (Mode of delivery not reported.) | NR | At a 12-month FU, no complication was present. |
Gotfryd et al. [20] (2015) | Moderate | Brazil | 20 / NR | MVA | 20th week | Fracture and dislocation of T4–T5 vertebrae | T6 Frankel scale A | Decompression, reduction, and fixation with pedicle screws | A normal healthy female baby was delivered through NVD. | NR | Patient neurological status at FU is not reported while at 2-year FU, her baby was normal. |
Engel et al. [9] (2013) | Moderate | Australia | 28 / primigravida | MVA | 12th week | Fracture dislocation of T6 vertebrae | T6 ASIA A | Posterior pedicle screw fixation (T4–T7), T5 / T6 vertebrectomy with iliac crest graft | 2.65-kg boy baby with arthrogryposis multiplex congenita was delivered by caesarean section. | UTI, anemia | At a 6-year FU, the patient remained T6 ASIA A paraplegic while her child had cerebral palsy. |
Baranović et al. [16] (2014) | Low | Croatia | Age / NR | MVA | 17th week | Luxation fracture of the C5 and C6 vertebrae | ASIA B | Disk extirpation and anterior spondylodesis | A normal healthy baby was delivered. (Mode of delivery not reported.) | NR | The patient achieved complete recovery of the neurological deficit within few days of the surgery. |
Sonawane et al. [2] (2018) | Low | India | 28 / G3P2 | Fall | 26th week | Burst fracture of T12 vertebra | L1 ASIA A | Laminectomy with posterior decompression and short-segment pedicular screw fixation | A normal healthy baby was delivered through cesarean section. | NR | At a 2-year FU, the patient was paraplegic with partial recovery of bowel and bladder function. |
Arsh et al. [7] (2017) | Low | Pakistan | Case 1: 30 / G6P5 | Fall | 24th week | NR | T12 ASIA B | Spinal injury managed conservatively | A normal healthy female baby was delivered through cesarean section. | Sacral PU & colostomy at FU | At a 3-year FU, the patient improved to ASIA C and she walked with AFO in the walking frame. |
Pakistan | Case 2: 25 / G3P2 | Fall | 30th week | NR | C5 ASIA A | ACDF | A normal healthy boy baby was delivered through assisted breech vaginal delivery. | UTI & bowel abnormalities at FU | At a 2-year FU, the patient remained C5 ASIA A tetraplegic. | ||
Pakistan | Case 3: 24 / G4P3 | MVA | 27th week | NR | C7 ASIA B | ACDF | A normal healthy female baby was delivered through assisted vaginal delivery. | UTI, hydronephrosis | At a 2-year FU, the patient improved to ASIA D and she walks with crutches. | ||
Pakistan | Case 4: 29 / G3P2 | MVA | 11th week | NR | L1 ASIA A | Spine fixation | A premature baby was delivered through NVD but died after 1 hour of delivery. | Multiple PU, anemia, depression | At a 1-year FU, the patient remained L1 ASIA A Paraplegic. | ||
Pakistan | Case 5: 38 / G4P3 | GSW | 21st week | NR | L1 ASIA C | Spinal injury managed conservatively | A normal healthy female baby was delivered through NVD. | Coccygeal PU; bowel and bladder disturbances at FU | At a 1-year FU, the patient improved to ASIA D and she walks without any support. | ||
Qureshi et al. [25] (2017) | Low | Saudi Arabia | 32 / primigravida | MVA | 2nd trimester (at the time of injury) 27th week (2 months post injury) | C6–C7 fracture dislocation | C6 ASIA B | Cervical spine decompression, C7 corpectomy and C6–T1 internal fixation | 1.7-kg premature baby boy was delivered through cesarean section. | AD, UTI, depression, PU, spasticity, urethral injury secondary to catheter pull, chest infection | At the time of discharge from rehabilitation, the patient was partially independent in ADLs. Patient neurological status at FU is not reported. |
Agrawal [18] (2018) | Low | India | 20 / G2P1 | MVA | 12th week | Anterior wedging of T11 and T12 vertebrae | No neurological deficit | T11–L1 pedicle screws and rod fixation | FU ultrasound of the fetus was normal as per the age of the fetus. | NR | NR |
Zemmar et al. [19] (2018) | Low | Yemen | Case 1: 30 / G5P3 | Fall | 23rd week | C5 / 6 fracture dislocation | C4 ASIA A | Anterior C5 corpectomy and C4–6 fixation | A normal healthy baby was delivered through NVD. | UTI, PU, hypotension, anemia | NR |
Yemen | Case 2: 26 / G5P4 | MVA | 18th week | C6 / 7 fracture dislocation | C5 ASIA B | Anterior C7 corpectomy and C6–T1 fixation | A normal healthy baby was delivered through NVD. | UTI, PU, DVT, anemia, hypotension | NR | ||
Yemen | Case 3: 30 / G3P2 | Fall | 17th week | T12 / L1 fracture dislocation | T11 ASIA A | T12 laminectomy and T11–L1 posterior instrumentation and fusion | A normal healthy baby was delivered. (In-text it was mentioned but in tabulated form, this case was left blank.) | UTI | NR | ||
Yemen | Case 4: 25 / G3P2 | Fall | 20th week | L1 wedge fracture | No neurological deficit | Spinal injury managed conservatively | A normal healthy baby was delivered through cesarean section. | UTI | NR | ||
Yemen | Case 5: 22 / G2P1 | MVA | 12th week | T7 wedge fracture | No neurological deficit | Spinal injury managed conservatively | Abortion | UTI, anemia, multiple trauma | NR | ||
Pedaballe et al. [12] (2018) | Moderate | India | 30 / G2P1 | MVA | 31st week | C4–C5 extension compression SCI | C4–C5 ASIA B | ACDF | A normal healthy baby was delivered through cesarean section. | NR | At a 1-year FU, the patient improved to ASIA D and she was ambulatory without any support. |
G, gravida; P, para; GA, gestational age; AIS, ASIA Impairment Scale; SCI, spinal cord injury; FU, follow-up; NR, not reported; MVA, motor vehicle accident; GSW, gunshot wound; ASIA, American Spinal Injury Association; NVD, normal vaginal delivery; UTI, urinary tract infection; PU, pressure ulcer; AD, autonomic dysreflexia; AFO, ankle foot orthosis; ACDF, anterior cervical discectomy and fusion; ADLs, activities of daily living; DVT, deep venous thrombosis.
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