Acute lumbar intervertebral disc prolapse: a complication of the lithotomy position

Choudhari, Kishor A.; Choudhari, Yashashri; Fannin, T. F.

doi:10.1111/j.1471-0528.2000.tb11679.x

Cited by 5 publications

(4 citation statements)

References 9 publications

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“…11 By placing the patient in the lithotomy position, flexion and hyperabduction of the hips made the stretching of the lumbosacral nerve roots worse and converted an occult pre-existing asymptomatic disc bulge into a frank disc prolapse with intractable sciatica and sensorymotor deficits. 13 Patients with spinal stenosis are more susceptible to symptomatic disc prolapse with relatively minor provocation as has happened in one of our patients whose MRI showed lumbar canal stenosis.…”

Section: Discussionmentioning

confidence: 87%

“…The patient was treated with L4/5 microdiscectomy. 13 Fortunately, neither of our cases needed surgical intervention and both responded well to the conservative treatment. Acute disc prolapse is an extremely rare complication of the lithotomy position.…”

Section: Discussionmentioning

confidence: 87%

“…However, because the force applied in the former is considerably less, only rarely is disc prolapse precipitated by the lithotomy position. 13 Another mechanism seems more likely. It is known that the upper and lower parts of lumbosacral plexuses can be stretched between their respective origins and exits, beneath the inguinal ligament and the greater sciatic foramen, respectively, by hyperabduction of the hip.…”

Section: Discussionmentioning

confidence: 97%

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Acute Lumbar Disc Prolapse: A Rare Complication of Lithotomy Position

SinghNisha

MeenakshiJohri

NegiNeha

2015

Journal of Gynecologic Surgery

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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)

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 97%

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Acute Lumbar Disc Prolapse: A Rare Complication of Lithotomy Position

SinghNisha

MeenakshiJohri

NegiNeha

2015

Journal of Gynecologic Surgery

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“…Abzugrenzen hiervon sind irreversible Schädigungen, die in ihrer Entstehung deutlich seltener und in der vorliegenden Studie bei der TUR-Blase nicht beschrieben sind. Weitere neuromuskuläre Komplikationen der Steinschnittlagerung stellen die Rhabdomyolyse [28], Bandscheibenvorfälle [29] oder das Kompartmentsyndrom dar [30], die jedoch nur in Einzelfällen berichtet wurden. Trotz der Seltenheit sind hier bei Beschwerden in der klinischen Routine eine frühzeitige Diagnose und eine zügige kausale Therapie von hoher Bedeutung.…”

Section: Lagerungsschädenunclassified

Komplikationsmanagement bei der TUR-Blase

Mally

Paffenholz

2020

Aktuelle Urol

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ZusammenfassungDie transurethrale Resektion der Harnblase (TUR-Blase) ist ein Standardeingriff der operativen Urologie. Eine komplette Resektion steht hierbei an höchster Stelle. Darüber hinaus ist die Kenntnis der möglichen Komplikationen und das dazugehörige Komplikationsmanagement für die klinische Praxis essenziell. Zu den häufigsten Komplikationen gehören katheterassoziierte Beschwerden, Blutungen, Infektionen und die Harnblasenperforation. Doch auch die Resektion des Harnleiterostiums und Lagerungsschäden stellen zwar seltenere, aber dennoch unmittelbar behandlungswürdige Komplikationen dar. In der vorliegenden Übersichtsarbeit werden diese Komplikationen zusammengefasst sowie deren Vorbeugung und Management vorgestellt.

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Voiding difficulty

Bombieri¹,

Freeman²

2011

Gynaecology

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Acute lumbar intervertebral disc prolapse: a complication of the lithotomy position

Cited by 5 publications

References 9 publications

Acute Lumbar Disc Prolapse: A Rare Complication of Lithotomy Position

Acute Lumbar Disc Prolapse: A Rare Complication of Lithotomy Position

Komplikationsmanagement bei der TUR-Blase

Voiding difficulty

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