Surgical Management of the Pregnant Patient With Lumbar Disc Herniation in the Latter Stage of the Second Trimester.
METHODS
Case report.


OBJECTIVE
To report on a pregnant woman successfully treated with microendoscopic discectomy in the left lateral position under general anesthesia at 24-week gestation.


BACKGROUND
Treatment for lumbar disc herniation in pregnant women poses a particular challenge due to the complexity of the clinical situation. Review of the literature emphasizes timely diagnosis with adequate management specific for each gestational period. A surgical approach mandates consideration of the physiologic parameters of pregnancy and the effects of these stressors on the fetus.


METHODS
A 38-year-old primigravid woman presented with persistent and incapacitating low back and left leg pain. Magnetic resonance imaging demonstrated a herniated disc at L4-5 with a severely compressed left L5 nerve root. Symptoms were resistant to conservative treatment (acetaminophen; 1200 mg/day) and nerve root block with corticosteroids (1 mg/0.5 mL of betamethasone plus 0.5 mL of 1% lidocaine) provided only transient pain relief. Operative management with surgical discectomy was discussed. Anesthesiologists, obstetricians, and neonatologists were consulted for preoperative planning, focusing on appropriate anesthesia, ideal positioning for surgical access, and provision for emergent fetal care. Surgery was ultimately performed in the left lateral position, in contrast to the oft-used prone position. Microendoscopic discectomy was performed under general anesthesia at 24-week gestation.


RESULTS
The patient experienced complete relief from pain after surgical intervention and delivered a healthy baby at 39-week gestation after normal labor. Our methods, used in accordance with our preoperative simulation, resulted in a satisfactory outcome for both mother and child.


CONCLUSIONS
Although previously published cases noted the safety of operating in the prone position under epidural anesthesia, we performed minimally invasive microendoscopic discectomy in the left lateral position in combination with general anesthesia and found that this is a safe and preferable alternative for pregnant patients in the latter stage of the second trimester.


METHODS
N/A.
Department of Orthopaedic Surgery, Garduate School of Medical Sciences, Nagoya City University, Nagoya, Japan.|Drexel University College of Medicine, Philadelphia, PA.
Kazuo
K
Hayakawa
Department of Orthopaedic Surgery, Garduate School of Medical Sciences, Nagoya City University, Nagoya, Japan.|Department of Rehabilitation Medicine, Garduate School of Medical Sciences, Nagoya City University, Nagoya, Japan.
Jun
J
Mizutani
Department of Orthopaedic Surgery, Garduate School of Medical Sciences, Nagoya City University, Nagoya, Japan.
Nobuyuki
N
Suzuki
Drexel University College of Medicine, Philadelphia, PA.
Christopher
C
Haas
Department of Orthopaedic Surgery, Garduate School of Medical Sciences, Nagoya City University, Nagoya, Japan.
Akira
A
Kondo
Department of Orthopaedic Surgery, Garduate School of Medical Sciences, Nagoya City University, Nagoya, Japan.
Seiji
S
Otsuka
Department of Orthopaedic Surgery, Garduate School of Medical Sciences, Nagoya City University, Nagoya, Japan.
Muneyoshi
M
Fukuoka
Department of Orthopaedic Surgery, Garduate School of Medical Sciences, Nagoya City University, Nagoya, Japan.
Takanobu
T
Otsuka
D000328:Adult; D017587:Diskectomy, Percutaneous / Q000379:methods; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000175:diagnosis / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008161:Lumbosacral Region / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods; D011247:Pregnancy; D011262:Pregnancy Trimester, Second / Q000502:physiology*; D016896:Treatment Outcome