Surgery for lumbar disc herniation during pregnancy.
METHODS
The case reports of three pregnant patients with lumbar disc herniation causing cauda equina syndrome or severe neurologic deficits are presented to illustrate that disc surgery during gestation is a safe method of management.


OBJECTIVE
To emphasize the importance of recognizing and definitively treating lumbar disc displacement causing neurologic deficits during pregnancy.


BACKGROUND
The advent of magnetic resonance imaging and modern surgical techniques for treatment of lumbar disc displacement allows safe management of this condition at any stage of gestation. A review of the literature on the risks of nonobstetric surgery and the risks of delaying disc surgery until delivery shows that operating at any stage during gestation for severe neurologic deficit secondary to lumbar disc displacement is justified.


METHODS
A review of the literature on the use of magnetic resonance imaging scan and nonobstetric surgery during pregnancy was performed. Three case reports of the authors' patients who had lumbar disc displacement with cauda equina syndrome or severe neurologic deficit are presented. Patients were placed prone on a four-poster frame, and an epidural anesthetic agent was administered. A one-level hemilaminectomy, partial facetectomy, and disc excision were performed in all three cases.


RESULTS
The methods used for diagnosis and surgical treatment of three patients with disc herniation during pregnancy resulted in a satisfactory outcome for both mother and child. The medical literature supports surgical intervention in pregnant patients with cauda equina syndrome and severe and/or progressive neurologic deficit(s) from lumbar disc displacement at any state of gestation.


CONCLUSIONS
Although extremely rare, cauda equina syndrome and severe and/or progressive neurologic deficit caused by lumbar disc displacement can occur during pregnancy. The prevalence of symptomatic lumbar disc herniation during pregnancy may be on the increase because of the increasing age of patients who are becoming pregnant. These cases showed, and the literature confirms, that pregnancy at any stage is no contraindication to magnetic resonance imaging scan, epidural and/or general anesthesia, and surgical disc excision.
Departments of Orthopaedics and Rehabilitation and Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA. Mbrown@med.miami.edu
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Levi
D000328:Adult; D002420:Cauda Equina / Q000473:pathology / Q000601:surgery; D017586:Diskectomy; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000473:pathology / Q000601:surgery*; D007405:Intervertebral Disc Displacement / Q000473:pathology* / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D011128:Polyradiculopathy / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000473:pathology / Q000601:surgery*; D013115:Spinal Canal / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome