Beyond the Epidural: A Single-Shot Spinal for Labor in a Patient with a Fused Spine

Background: Epidural analgesia is the standard for labor pain control. However, patients with prior spinal fusion present unique challenges to neuraxial access due to altered anatomy.

Case:A 28-year-old multiparous woman with thoracolumbar spinal fusion from childhood scoliosis presented in labor. During a prior delivery, epidural analgesia was ineffective and produced severe paresthesias. Given the anatomic distortion and prior failure, the care team opted for a single-shot spinal at 8 cm dilation. The patient achieved excellent analgesia and had an uncomplicated vaginal delivery.

Conclusion:Single-shot spinal anesthesia, though uncommon for labor, may be a valuable alternative when epidural placement is contraindicated or technically difficult due to spinal fusion.