Expert: Ronald Levy, M.D. - 2/18/2010

Question
In 2005 I had a lumbar spine fusion which fused all of my lumbar spine and my tail bone. As it was explained to me there is no space between my vertebrae. During my surgery they used cadaver bone, pins, screws, and plates. When the final injury happened before my surgery my sciatic nerve was severed and never healed, this caused me to have numbness in my left leg and hip.
I am now 28 weeks pregnant and we are trying to figure our options for delivery. The prospect of having a natural birth has gone back and forth. Because of the pain I am already experiencing in my back the doctors are unsure if I will handle labor. However, they are unsure if I will be able to have an epidural or a spinal tap. In your experience do you believe it would be possible for me to have either of these? Before my surgery I had 3 epidurals to try and help with pain and they were not successful, will they work this time?
Thank you so much for any help you can give me.

Answer
While it is possible to do a spinal (less so for an epidural), it would have to be done from a paraspinous approach (which is much more difficult and not commonly performed. It is possible that the anesthesiologist could place the epidural in the space above your fusion but considering you already have some numbness in you leg, they might shy away from that. If you are coming for an elective c-section, you could probably arrange to have someone skilled in the procedure pre-arranged to do it but if it is an emergency c-section, I am pretty sure they will go with a general anesthetic. You also have a much higher risk of an incomplete or patchy block which might also require you to be put to sleep. My personal recommendation considering the # of vertebrae fused would be to have a general anesthetic for an elective c-section.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston