Magnetic Resonance Imaging of the Lumbar Herniated Disc in Pregnancy

LaBan, Myron M.; Viola, Sherry; Williams, Dennis A.; Wang, Ay-Ming

doi:10.1097/00002060-199501000-00010

Cited by 28 publications

(23 citation statements)

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“…As more than 30% of pregnant women are over 30 years of age nowadays (our patient was aged 31) [3,4], physicians should be aware of lumbar disc herniation in older pregnant patients with leg pain [3]. The literature clearly demonstrates that pregnancy at any stage is not a contraindication for MRI or for the administration of epidural or general anesthesia [5]. MRI, which we used in our patient, is the definitive diagnostic procedure for lumbar disc herniation and demonstrated a symptomatic lateral disc herniation at the L5-S1 level.…”

Section: Discussionmentioning

confidence: 96%

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Anesthetic management of lumbar discectomy in a pregnant patient

İyilikçi

Erbayraktar

Tural

et al. 2004

Journal of Anesthesia

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ate weakness of the right ankle dorsal and plantar flexions (muscle strength 3 and 4/5, respectively) in the right lower extremity. The Achilles reflex was depressed and pinprick sensation was decreased over the right L5 nerve root dermatome. As magnetic resonance imaging (MRI) demonstrated a central disc herniation at the L5-S1 level, causing severe compression to the right L5 root, surgical decompression was planned on the same day. The obstetricians also evaluated her. According to an ultrasonographic examination, the fetus was healthy, and a fetal heart rate of 140-160 beats·min Ϫ1 was recorded.She was then transported to the operating room, in the lateral decubitis position, where standard monitoring by continuous electrocardiography, noninvasive blood pressure measurement, and oxygen saturation (M1094B; Hewlett Packard, Saronno, Italy) were established. A peripheral venous cannula was also inserted. Before the induction of anesthesia, she was preoxygenated with 6 l·min Ϫ1 oxygen for a period of 5 min. The operating table was maintained in the left tilt position. Induction was achieved with 2 mg·kg Ϫ1 propofol. Vecuronium (0.1 mg·kg Ϫ1 ) was given to facilitate tracheal intubation, with a size 7.5 tube. Anesthesia was maintained with 1%-1.5% sevoflurane in a mixture of oxygen and air (Narkomed; North American Dräger, Telhord, PA, USA) following tracheal intubation. She was placed in the left lateral position and her abdomen was supported with pillows in order to prevent direct pressure on the fetus. Throughout the L5-S1 discectomy operation, which lasted for 2 h, neither fetus nor mother exhibited any hemodynamic change. The fetal heart rate was monitored with Doppler ultrasonography during the induction of anesthesia, emergence, recovery, and whenever possible during surgery. No change was detected in the fetal heart rate (140-160 beats·min Ϫ1 ). At the end of the operation, she was extubated immediately. The postoperative period was smooth and her neurological deficits recovered gradually. Her general

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Section: Discussionmentioning

confidence: 96%

“…In a series of 48 760 consecutive deliveries, LaBan and colleagues [4,5] diagnosed symptomatic herniated lumbar disc by myelography in five pregnant patients. Although extremely rare, cauda equina syndrome and severe neurological deficit caused by lumbar disc herniation may occur during pregnancy [2,3].…”

Section: Discussionmentioning

confidence: 99%

Anesthetic management of lumbar discectomy in a pregnant patient

İyilikçi

Erbayraktar

Tural

et al. 2004

Journal of Anesthesia

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“…BP is a very common disease during pregnancy, with many authors estimating that about half of pregnant women suffer it [8,25]. Several studies have assessed the frequency of the disease [4,13], the clinical picture [5,24,25], therapies [11,27] and follow-up [3,16,17].…”

Section: Discussionmentioning

confidence: 99%

Back pain in pregnancy: 1-year follow-up of untreated cases

et al. 2004

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IntroductionBack pain (BP) is one of the most frequent symptoms to appear during the last period of pregnancy and a high incidence has been described in several studies [2,6,7,9,14,17]. Since 1984 modern studies of BP also need to include patient-oriented assessment [23]. Self-administered questionnaires are the most common instruments to assess patient perspective in evaluating the clinical picture, and the usefulness of these instruments [20, 21] is widely accepted. BP during pregnancy has been quantitatively evaluated in some recent papers, but only a few studies analyzed the symptoms from a qualitative-quantitative point of view, using a validated patient-oriented tool [16,25].During 2001, we performed a study to assess the incidence and severity of BP during the last period of pregnancy, through a modern and comprehensive assessment of the patient's perspective [18]. That study demonstrated that the incidence of BP in pregnancy is high (about twothirds of our sample have BP symptoms), but most often BP causes only low-grade disability.Until now no multicenter and prospective clinical studies on the natural course of BP after pregnancy have been available (multicenter studies are commonly accepted as providing a more representative sample). We performed the follow-up of the previous studied sample; consequently, we acquired data from a multicenter sample. We used a validated patient-oriented measurement, the Roland questionnaire, to obtain more comprehensive and consistent Abstract Back Pain (BP) is one of the most frequent symptoms during the last period of pregnancy, and high incidence has been described in several studies. Until now no wide, multicenter and prospective clinical studies on the natural course of BP after pregnancy have been available. We performed a multicenter follow-up study in a sample of pregnant women using the Italian validated version of the Roland questionnaire to assess the evolution of BP after pregnancy and identify prognostic factors. Each center had to re-evaluate at least 75% of the initially enrolled women, with latency of 1 year after delivery. At the follow-up, we acquired substantial clinical data concerning the post-delivery period. The evaluation of symptom evolution was based on the Roland questionnaire. At followup, 53% of re-evaluated women had no BP symptoms. Moreover, there was a significant improvement of patient-oriented assessment in women who suffered BP after delivery. With regard to the predictive factors, the presence of BP before pregnancy implied a 3.1-fold higher probability of improvement after delivery. In conclusion, women without history of BP before pregnancy and who complain of these symptoms during pregnancy require greater attention, because they have a lower possibility for improvement. Conversely, in women with a history of BP, pregnancy represents a transient period of worsening symptoms, probably due to the temporary para-physiological mechanical condition.

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“…MRI without the use of gadolinium chelates now allows detailed evaluation of HDD without exposure of the fetus to the potential negative effects of ionising radiation [65,104]. Abnormal disk encountered in asymptomatic pregnant women as well as the high prevalence of anatomic abnormalities discovered in asymptomatic people highlight the importance of careful correlation of symptoms and findings at MRI [20,92,104,170]. In the presence of symptomatic HDD, elective caesarean section may be the preferred route of delivery with the anticipation that increasing epidural venous pressure, which is an indirect measure of CSF pressure, could precipitate progressive neurological dysfunction [103].…”

Section: Sciatica In Pregnancymentioning

confidence: 99%