Delivery after spinal fusion

[Meh12345]

Hey

im hoping there might be someone who has been in a similar situation. About 6 years ago I had spinal fusion surgery with hardware. The surgery was successful which I am very grateful for. However I am very conscious that I will not be able to have an epidural during delivery. The midwife has referred me to the anaesthetist to discuss pain relief options. My fusion is in my L4/5, has anyone been in this situation and able to advise how delivery went and what pain relief they were able to have?

Hi, I haven’t had a spinal fusion but didn’t want to read and run! I have recently been diagnosed with a herniated disc at L5-S1, bulging discs above that, an annular tear, foraminal stenosis and compression of the S1 nerve root mainly in the left but also in the right, I am also very nervous about what options I’m going to have regarding delivery.
Hoping you get some good news from the anaesthetist. Perhaps an elective C section might be an option? Let me know how it goes :)

The anaesthetist will be able to advise re pain relief & anaesthetic options and they’ll be able to liaise with the spinal surgeon if necessary. The metalwork’s important but needs to be considered alongside any other medical problems/risk factors you have and the options available wherever you’re booked. In very general terms, metalwork that far down might not be an absolute contraindication for an epidural but an epidural might not work so well because of scar tissue - anaesthetist’ll be able to have a proper think about things specific to you though. A spinal anaesthetic would normally be ok for anything in theatre if needed/appropriate in the context of the rest of your history & exact scenario. If they do advise not to try an epidural and you’re planning a vaginal delivery it might be worth exploring whether remifentanil’s an option where you’re booked (or perhaps transferring to a unit where it is an option). HTH.

Obs anaesthetist

We generally won't do epidurals for metal work as the risk of introducing metal work infection that would be awful as may require all the metal work removing

Some trusts, providing the metal doesn't go higher, will do spinals for theatre (forceps or csection) - but they'd need to see your xrays as we do them at l3/4 level (2nd choice being l4/5) as the risk of infection is lower with a single injection vs plastic tube in the back for hours. We are super careful on checking the block as the metal work can affect the spread of the anaesthetic drug

Some anaesthetists are super cautious and would only offer ga sections (and if a spinal didn't work would be a ga conversion)

For labour you'd have the standard gas and air, an injection of either pethidine or diamorphine (do similar some trusts offer one or the other)

The other best option for spinal metal work providing you meet criteria (bmi <40, not got not twins, not premature or fetal abnormalities etc) then would be a remifentanil pca so a clicky button device that you press with contractions and gives high dose iv opiate that is v short lasting.

You need to check early on whether your labour ward offers this and if they do it commonly as some places do it all the time and it's easy to arrange. Others rarely do and it's hard to get, a some don't offer fullstop as it needs Specialist midwifery training and it's higher from a work load perspective as the midwife can never leave your room

So I'd phone around and ask to deliver somewhere familiar with remi that use it a lot

If you go on labourpains.org that's written by obs anaesthetists and gives you loads of different info on the options I've said above, and you'll be phoned by one of us in late pregnancy to discuss all this in advance

Best of luck

Disc herniations don't affect us, all the standard choices are available