The Surgical Management of Lumbar Disc Disease with Neurological Deficits During Pregnancy

Objective:

Low back pain during pregnancy is almost universal, however the incidence of symptomatic lumbar disc herniation with neurological deficits has been estimated to be one in ten thousand pregnancies. Concerns about the safety of investigating and treating this condition during pregnancy has resulted in a non–surgical approach.

Methods:

We review 3 cases of lumbar disc herniations who presented during pregnancy with profound neurological deficits which were managed with surgery and focus on the presentation; safety of imaging, positioning and anesthesia as well as the maternal and fetal outcomes.

Results:

The average age of the expectant mothers was 35 years (31, 32, and 41), all of whom presented in the early second trimester (average = 19 weeks). One patient suffered from a cauda equina syndrome and the other two patients from severe motor and sensory deficits in the S1 and L5 nerve roots respectively. All patients were found to have an LSSI disc herniation on MRI which were central, paracentral and far lateral in location explaining the above syndromes. The patients positioned themselves in the prone position on a frame and received an epidural anesthetic with no significant change in fetal monitoring performed pre– and post–operatively. Lumbar disc excision was performed at LSS1. All patients had a substantial improvement in neurological function and reduced pain post–operatively with the delivery of healthy infants at term.

Conclusion:

Pregnancy is not a contraindication to MRI scan, epidural anesthesia, and surgical disc excision. Surgery appears warranted in patients who present with a severe and/or progressive neurological deficit secondary to a lumbar disc herniation.