Case report: The operation for the lumbar disk herniation just after cesarean delivery in the third trimester of pregnancy

Abstract

HighlightsWe suggest treatment strategy for a pregnant woman with lumber disk herniation.The discectomy was performed just after cesarean delivery in the third trimester.There were not any complications with mother and baby after operation.It is necessary to cooperate with a pediatrician, an obstetrician, and an anesthesiologist.It is important to discuss in advance to be able to respond quickly for changeable situation.

Managing Symptomatic Severe Disc Prolapse in Pregnancy with Normal Vaginal Delivery: An MDT Approach

“…The decision of whether to interrupt the pregnancy would be a multi-professional involving the patient, spinal surgeon, neonatologist, midwife and Obstetrician. Ochi et al suggest a protocol to aid the decision making process of continuing or interrupting the pregnancy and in cases where the prone position cannot be safely achieved but delivery is considered too risky for the fetus then surgery in the lateral position is suggested [7].…”

“…In severe cases where conservative measures have failed to control the symptoms, women can be operated safely in the first and second trimester and then continuing with the pregnancy until term [5]. However in the third trimester, the gravid uterus may mean that the desired positioning cannot be achieved [7]. After 34 weeks, delivery prior to corrective surgery may be considered weighing up the relatively lower risk of complications of prematurity at this gestation against the technical challenges of operating including the difficulty in monitoring fetal well-being.…”

“…Cauda Equina occurs when spinal cord compression gives rise to symptoms of loss of sensation in the saddle area, loss of bladder sensation, with possible urinary and faecal incontinence. It is an absolute indication for urgent surgery to prevent long term sequele irrespective of the gestation.Ideally these procedures are usually performed in a prone position to minimise blood loss and allow access to the surgical field [7], however surgery in the left lateral position are reported [8] although there are concerns about the possibility of a longer procedure with an increase in blood loss [9]. In severe cases where conservative measures have failed to control the symptoms, women can be operated safely in the first and second trimester and then continuing with the pregnancy until term [5].…”

“…The decision of whether to interrupt the pregnancy would be a multi-professional involving the patient, spinal surgeon, neonatologist, midwife and Obstetrician. Ochi et al suggest a protocol to aid the decision making process of continuing or interrupting the pregnancy and in cases where the prone position cannot be safely achieved but delivery is considered too risky for the fetus then surgery in the lateral position is suggested [7].There is no clear cut guidance on mode of delivery in such cases. Historically caesarean section has been chosen as preferred mode of delivery due to the theoretical risk of a raised intra-thecal pressure with the second stage as well as convenience of combining caesarean delivery with the spinal surgery.…”

“…In our case, this lady had a previous uncomplicated twin vaginal delivery and so the chances of a successful vaginal delivery when established were high. Irrespective of mode of delivery epidural anaesthesia can be administered in the presence of a lumbar prolapse [7].In women who had corrective surgery prior to pregnancy, an observational study of 41 women comparing the effectiveness of regional anaesthesia found no difference however reported a higher rate of requiring multiple insertions [10]. Whereas in 21 women who had regional anaesthesia in labour within the study by Sven et al found that 52% were not satisfactory [11].…”