Oh my gosh! How awful for you! You should see a neurologist or get another obgyn's opinion before you do anything permanent. If the doctors were unable to find a cause, how can they tell pregnancy is the only thing wrong or that you could become paralized? If you feel in your heart you really don't want to risk it, then terminating the pregnancy is what you should do, but be sure you have covered all options to find out if this condition can't be remedied before you have to go through something so emotionally painful. God Bless you and keep you. Below is some info I found that you might find interesting and hopfully helpful. I'll keep you in my prayers. K.
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Case Report
History and Examination
This 26-year-old obese women, gravida 1, para 0, in her 24th week of pregnancy presented with a 3-week history of upper-back pain, leg paresthesia, progressive difficulty walking, and leg weakness. She did not have headaches, fevers, chills, or incontinence. She had received routine prenatal care, and her pregnancy was unremarkable until onset of symptoms indicative of a hemangioma. On evaluation, she exhibited profound myelopathy with 3/5 motor strength in the legs, a T-10 sensory level, and hyperreflexia with sustained clonus in the legs. Examination of the arms revealed only slight intrinsic muscle weakness of the left hand.
Neuroimaging
Admission MR imaging of the spine revealed an isolated C-7 vertebral body lesion with extradural extension and compression of the spinal cord, and evidence of T2signal abnormality within the cord (Fig. 1A and D). Gadolinium contrast material was not administered because of the patient's pregnancy. The lesion appeared to expand the entire vertebral body, but did not involve adjacent disc spaces or paravertebral soft tissues. Admission CT scanning revealed a honeycomb-patterned C-7 vertebra and large vacuolated spaces within the entire spinal column, including posterior elements (Fig. 2). These findings were consistent with a vertebral hemangioma.
Figure 1. (click image to zoom)
A–C: Sagittal T2-weighted noncontrast-enhanced cervical spine MR images obtained preoperatively (A), on Day 3 postoperatively (B), and 2 weeks postpartum (4 months postoperatively, C). D–F: Axial postoperative T2-weighted noncontrast-enhanced MR images through the C-7 vertebral body (T2-weighted fat-suppressed sequence, D), on Day 3 postoperatively (E), and 2 weeks postpartum (4 months postoperatively, F). Improvement of ventral epidural mass effect is seen postsurgery, with progression of paravertebral hemangioma (arrows).
Figure 2. (click image to zoom)
Preoperative CT scans with reconstruction of the lower cervical spine in sagittal (A), coronal (B), and axial (through the C- 7 vertebra, C) views demonstrating a classic honeycomb pattern involving the entire C-7 vertebra, consistent with hemangioma (arrows).
Initial Treatment
The patient was initially given glucocorticoid boluses (4 mg Decadron intravenously every 6 hours) and remained stable for 3 days on bedrest. On Day 4 of her hospitalization, she experienced a decline in motor function, prompting emergency decompression. Repeated MR imaging performed at that time revealed no changes in the lesion.
Operation
Anterior cervical corpectomy was performed through a wide, low-anterior neck dissection. Care was taken to preserve the right recurrent laryngeal nerve. Continuous fetal heart monitoring was performed by an obstetric nurse during surgery. There were no signs of fetal distress during the operation. Extensive bleeding was encountered during corpectomy; an estimated blood loss of approximately 2.5 L necessitated transfusion of 2 U of blood. Corpectomy at C-7 was achieved and osseous bleeding was easily stopped with bone wax. Extradural hemangioma tissue overlying the dura mater was partially removed, but extensive bleeding prevented complete resection. Cadaveric tibia allograft was used for a bone graft, and standard anterior cervical plate stabilization was performed. Several specimens were obtained intraoperatively and sent to the Department of Pathology for histological examination. No fluoroscopy was used during the operation.
Histological examination demonstrated fragments of bone with prominent vascular channels, vascularized fibrous tissue, and benign vascularized fibroadipose tissue, which were consistent with a diagnosis of osseous hemangioma. Postoperative MR imaging demonstrated subtotal resection of the hemangioma and persistent extradural compression of the spinal canal (Fig. 1B and E).
Postoperative Course
After surgery her paresthesias resolved and motor strength in both legs improved to 4+/5 within 1 week. At the time of discharge, the patient exhibited hyperreflexia and clonus in the lower extremities but was ambulating with a walker. There were no complications regarding her pregnancy at any time during her stay in the hospital.
At 40 weeks gestation, the patient delivered a healthy baby by normal spontaneous vaginal delivery. The baby's Apgar score was 8 and 9 and its weight was 3420 g. By the time of delivery, the patient was ambulating independently and had attained full strength in her legs, normal bowel and bladder function, and resolution of pain. Residual weakness and numbness of the left hand was minimal and did not interfere with her normal daily activities. Postpartum MR imaging demonstrated a decrease in extradural spinal compression, but extension of the hemangioma into the paravertebral space (Fig. 1C and F) was seen. A cervical x-ray film demonstrated a stable fusion graft and normal spinal alignment (Fig. 3).
Figure 3. (click image to zoom)
Postoperative x-ray films revealing lateral swimmer's (A) and anteroposterior (B) views of the cervical spine 4 months postoperatively.
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References
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Author Information
John H. Chi, M.D., M.P.H., Geoffrey T. Manley, M.D., Ph.D., and Dean Chou, M.D., Department of Neurological Surgery, San Francisco General Hospital, University of California, San Francisco, California
Neurosurg Focus. 2005;19(3) ©2005 American Association of Neurological Surgeons
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