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Re: Triple Laminectomy From: Arthurfree@aol.com Sat Mar 8 11:53:39 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Arthurfree@aol.com: "Re: Vicryl at C Sections" Previous message: DOCJOE2855@aol.com: "Change of Address" Maybe in reply to: Timothy C. A. Brown, M.D.: "Triple Laminectomy" Next in thread: douglas krell: "Re: Triple Laminectomy" In a message dated 97-03-07 13:26:04 EST, you write: > >Timothy C. A. Brown, M.D. wrote: >> >> A 25 yo G2P1 woman s/p triple laminectomy and subsequent vaginal >> delivery (5 lb premie) is requesting an elective primary C-section >> because her back significantly worsened after her first delivery. >>Assuming she >> can get an orthopedist to state in writing that there is a definite >> risk of further injury in another vaginal delivery that can be >> avoided by elective C-section, this strikes me as a reasonable >> request. Your thoughts and comments will be appreciated. Your decision here is easy, it is the orthopod who has to make the value judgement based on the reason for the patient's original surgery and the extent of her disease. There is no question that labor can worsen disk disease, especially second stage. Both exaggerated flexion of the lumbar spine and valsalva can increase symptoms (and theoretically extrude more disk material). I'm surprised we don't see it happening more often in our "older" gravids. But disk disease does stabilize, and if she's been operated at three levels, she may actually have had as much grief from her disks as she can have. The patient who should probably be considered for elective section is the patient with new (within six months or so) radicular symptoms and a history consistent with disk disease. > >In my lifetime series of one such patient (my office nurse) she had a >normal vaginal delivery with child # 1, then a triple laminectomy for >a schwannoma that was definitely causing radiculopathy/bladder Probably not germaine if, as I assume, the laminectomy was due to disk disease. It is the underlying problem which may cause her to worsen with labor, not having had the procedure itself. Arthur Freeland Warrensburg Missouri Next message: Arthurfree@aol.com: "Re: Vicryl at C Sections" Previous message: DOCJOE2855@aol.com: "Change of Address" Maybe in reply to: Timothy C. A. Brown, M.D.: "Triple Laminectomy" Next in thread: douglas krell: "Re: Triple Laminectomy"

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