Diskectomy during Pregnancy: Case Report and Review of the Literature

Kanas, Michel; Kunzle, Hugo; Martins, Délio Eulálio; Kirsch, Luiz A.; Puertas, Eduardo Barros; Wajchenberg, Marcelo

doi:10.1055/s-0034-1387178

Cited by 8 publications

(5 citation statements)

References 18 publications

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“…Pregnancy has unique risks during general anesthesia, both to the mother and the fetus [10]. For these reasons, many anesthesiologists try to avoid general anesthesia if possible and instead opt for regional anesthetics, which carry the decreased risk of systemic toxicity [4]. Maternal safety and avoidance of fetal hypoxia and subsequent preterm labor are crucial when pregnant patients receive anesthesia [11].…”

Section: Discussionmentioning

confidence: 99%

“…There are important considerations that need to be addressed in pregnant patients with disc herniation, such as which drugs and diagnostic tests are safe during pregnancy, the surgical indications, the ideal time and technique for the procedure, the appropriate anesthesia, and the continuation of the pregnancy after surgery. Few studies exist in the current literature regarding this subject, and at this time, widely recognized treatment protocols have not been established [4].…”

Section: Introductionmentioning

confidence: 99%

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Microdiscectomy Under Local Anesthesia and Spinal Block in a Pregnant Female

Babici¹,

Johansen²,

Newman³

et al. 2021

Cureus

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The surgical plan and the anesthetic approach are vital in determining the proper treatment of lumbar disc herniation in pregnancy. The diagnostic tools available, as well as the anesthetic agents and methods of delivery, vary in pregnant patients due to factors such as radiation exposure and hemodynamics in the patient and fetus. The gestational age also plays an important role in determining treatment options. When possible, surgery should be avoided during the first trimester, especially during the period of organogenesis, as general anesthesia can interfere with this process. However, when focal neurological deficits are present, urgent surgical decompression may be necessary. In such cases, the selection of anesthesia must be guided by maternal indications and the nature of the surgery. Maternal safety and avoidance of fetal hypoxia and subsequent preterm labor are crucial when pregnant patients receive anesthesia. As a result, local anesthesia is often preferred when possible due to the decreased risk of systemic toxicity. Decompression surgery in pregnant females with lumbar disc herniation, using a multidisciplinary approach among the surgeon, obstetrician, and anesthesiologist, is an effective and safe procedure for both the mother and the fetus. We present the case of a pregnant female at four weeks of gestation who presented with lower back pain radiating down her right leg. MRI of the lumbar spine showed large L4-5 disc herniation. She underwent a successful right L4-5 microdiscectomy under local anesthesia and spinal block using bupivacaine and was completely awake throughout the procedure. Postoperatively, she experienced immediate improvement of symptoms.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Microdiscectomy Under Local Anesthesia and Spinal Block in a Pregnant Female

Babici¹,

Johansen²,

Newman³

et al. 2021

Cureus

View full text Add to dashboard Cite

show abstract

“…Although a single diagnostic X-ray procedure with exposure < 5 rads has not been associated with harmful fetal anomalies or pregnancy loss (14), a decision was made in our case to avoid fluoroscopy. Classical anatomic landmarks (the iliac crest line and palpating for the second interlaminar space cranial of the sacrum -both indicating the L4-L5 level) were successfully used to determine the appropriate level for the skin incision (15).…”

Section: Discussionmentioning

confidence: 99%

Progressive muscle weakness due to lumbar disc herniation in pregnancy: A case report

Rečnik¹

2021

AMB

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Purpose: Low back pain with radiculopathy caused by lumbar disc herniation is a rare presentation in pregnancy. Appropriate management is based on helping the gravida, while protecting her unborn offspring. Case report: A case of a 35–year–old pregnant woman in the 15th week of pregnancy with disabling pain and progressive motor weakness due to L4–L5 disc herniation is presented. Surgical decompression was performed with an aim to alleviate disabling pain and improve muscle strength. Conclusions: Treatment of disc herniation in pregnancy is conservative in the majority of cases. In the rare likelihood of permanent neurologic sequelae, surgical decompression is indicated, taking into account the specific physiologic condition of pregnancy.

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“…Clinical examination of subtle neurological disturbances is of paramount importance in diagnosing cauda equina syndrome. Subtle bowel and bladder disturbances might be overlooked during pregnancy leading to delayed diagnosis and irreversible neurological deficits [6]. MRI is safe and is the radiological investigation of choice in pregnancy and provides excellent aid in early diagnosis [7].…”

Section: Discussionmentioning

confidence: 99%

Cauda equina syndrome in an obese pregnant patient secondary to double level lumbar disc herniation – A case report and review of literature

Shetty

Kanna

et al. 2019

Spinal Cord Ser Cases

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Introduction Lumbar disc herniation during pregnancy poses a significant challenge to the spine surgeon towards achieving good clinical, maternal, and fetal outcomes. Surgical intervention is warranted in patients with significant neural deficits, and cauda equina syndrome and needs to be performed at the earliest in order to avoid irreversible neurological sequelae. Case presentation We report a 29-year-old primigravida in her 21st week of gestational period, who was diagnosed with cauda equina syndrome secondary to two level lumbar disc herniations. The lengthier surgical duration in performing double level disc herniations in an obese patient raises concerns in anesthetic dosing of drugs and surgical positioning which may result in fetal distress. A double level decompression and discectomy in prone position was done under general anesthesia. Despite the surgical challenges, the postoperative period was uneventful resulting in immediate pain relief and complete neurological recovery, followed by the delivery of a 2.7-kg healthy male child. Discussion Surgical intervention can be performed in pregnancy, to avoid irreversible neurological deficits, even in an obese individual with double level lumbar pathology. However, it is essential that the surgeon appraises the situation and involves an integrated multidisciplinary team comprising anesthetist, spine surgeon, obstetrician, and psychologist, and inculcates certain precautions in the perioperative management to achieve good surgical and fetal outcomes.

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Diskectomy during Pregnancy: Case Report and Review of the Literature

Cited by 8 publications

References 18 publications

Microdiscectomy Under Local Anesthesia and Spinal Block in a Pregnant Female

Microdiscectomy Under Local Anesthesia and Spinal Block in a Pregnant Female

Progressive muscle weakness due to lumbar disc herniation in pregnancy: A case report

Cauda equina syndrome in an obese pregnant patient secondary to double level lumbar disc herniation – A case report and review of literature

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