Surgery for Recurrent Lumbar Disc Herniation During Pregnancy: A Case Report

Abstract

A few cases of lumbar disc herniation (LDH) that have been treated by surgery during pregnancy have been reported in the literature. However, symptomatic recurrent LDH during pregnancy has been rarely reported. A 32-year-old parous woman presented with lumbago and severe right leg pain at 20 weeks' gestation. Eleven years prior to admission, she had undergone an open discectomy for right-sided LDH at the L4-5 level. Magnetic resonance imaging (MRI) showed a recurrent disc herniation that affected the nerve root at the right L4-5 level. The radiating pain did not respond to conservative treat-ment. Revision surgery was performed under general anesthesia and in the left lateral position to avoid fetal stress and aortocaval compression, and the ruptured disc particle was completely removed. Postoperatively, the radiating pain was completely relieved. She delivered a full-term healthy girl (birth weight, 3.39 kg) at 40 weeks' gestation by normal vaginal delivery. We report the rare case of a 32-year-old parous woman with recurrent LDH that was successfully treated by revision surgery. In recurrent LDH patients with incapacitating pain who do not respond to opioid injections, surgical treat-ment could lead to a satisfactory outcome maintaining pregnancy.

Low Back Pain in Pregnancy: Investigations, Management, and Role of Neuraxial Analgesia and Anaesthesia: A Systematic Review

“…MRI was most commonly used modality (17 publications) for diagnosing the cause of LBP, especially when LBP was associated with neurological symptoms in the lower limb such as radicular pain, paraplegia and/or cauda equina [18,[38][39][40][41][42][43][44][45][46][47][48][49][50][51] . The underlying pathologies associated with these presentations included herniation of intervertebral discs [18,[38][39][40][41][42][43][44][45][46] , vertebral hemangiomas [51] , spinal body tumour [44] , and tuberculosis [44] ( Table 1 ).…”

“…The underlying pathologies associated with these presentations included herniation of intervertebral discs [18,[38][39][40][41][42][43][44][45][46] , vertebral hemangiomas [51] , spinal body tumour [44] , and tuberculosis [44] ( Table 1 ). MRI was also used to investigate LBP in pregnant women with co-existing hip pain, with 3 studies reporting inflammation of the SIJ as the underlying cause [52][53][54] and 10 studies describing sacral fractures [55][56][57][58][59][60][61][62][63][64] .…”

“…Eight case reports and 2 case series described surgical interventions for intervertebral disc herniation causing neurological deficits (sensory, motor, bladder, or bowel involvement) including discectomy (open [38,39,41] , micro-discectomy [18,42] , or endoscopic [45] ), laminectomy [46] , or both [40,43,44] ( Table 2 d). Three case reports [47,48,50] and one literature review [91] described surgical management of vertebral fractures and vertebral hemangiomas respectively.…”

“…Most common pathologies diagnosed on imaging in pregnancy include intervertebral disc herniations, vertebral hemangiomas and fractures and sacral stress fractures. MRI is the most commonly used imaging modality for pregnant women with neurological compromise (dermatomal lower limb numbness [38] , perineal numbness [39,40] , lower limb weakness [18,39,40,43,45,46] , or loss of bladder/bowel control [40,43,45] ). Suspected disc herniation was the most frequent reason for imaging, followed by incapacitating LBP without neurological compromise [42] .…”

“…Choice of imaging modalities for investigating LBP during pregnancy is affected by the desire to avoid ionizing radiation exposure to the fetus. Concerns regarding maternal and fetal well-being also entail the use of conservative treatment regimens [18] .…”