Acute Lumbar Disc Prolapse: A Rare Complication of Lithotomy Position

Abstract

Background: Lithotomy is a common position in various gynecologic, urologic, orthopedic, colorectal, and pediatric surgeries. Neurovascular injuries described with the lithotomy position depend on the degree of lithotomy, type of surgery, and duration of surgery. These injuries include aseptic necrosis of femur head, ligamentous relaxation of the back, peroneal nerve injury, tibial nerve injury, vessel compression, compartment syndrome, compression ulcers, and disc prolapse. In this study, we report two rare cases of acute lumbar intervertebral disc prolapse following surgery for uterovaginal prolapse. Cases: A 35-year-old P2 + 0 with thirddegree cervical elongation underwent Fothergill operation, and a 52-year-old postmenopausal woman with thirddegree uterovaginal prolapse underwent Ward Mayo's hysterectomy, both under spinal anesthesia. There were no other comorbidities and both were found to be absolutely fit in the preanesthesia assessment before surgery. The procedures lasted for 90 and 100 minutes, respectively, and were uneventful. On the fifth and third postoperative day, they complained of low backache, pain radiating to the lateral aspect of both the lower limbs, and weakness in both lower limbs. Contrast MRI of the lumbosacral spine showed disc protrusion at the L5-S1 level in both cases. They were managed conservatively with the use of lumbosacral belt and spinal extension exercises. Both patients symptomatically improved and regained full strength and reflexes in both the lower limbs over a period of 3 months. Conclusions: Apart from detailed history and examination during preoperative evaluation, one must be careful while positioning the patient in lithotomy for any surgery. The process of positioning should be smooth and simultaneous bilaterally to avoid neuropathies. In the postoperative period, MRI should be done to exclude disc prolapse if the patient's signs and symptoms suggest so. Most patients can be treated conservatively. ( J GYNECOL SURG 31:367)