Case report.
To report on a pregnant woman successfully treated with micro-endoscopic discectomy in the left lateral position under general anesthesia at 24 weeks gestation.
Treatment for lumbar disc herniation in pregnant women poses a particular challenge due to the complexity of the clinical situation. Review of the literature emphasizes timely diagnosis with adequate management specific for each gestational period. A surgical approach mandates consideration of the physiologic parameters of pregnancy and the effects of these stressors on the fetus.
A 38 year-old primigravid woman presented with persistent and incapacitating low back and left leg pain. Magnetic resonance imaging demonstrated a herniated disc at L4-5 with a severely compressed left L5 nerve root. Symptoms were resistant to conservative treatment (acetaminophen; 1200 mg/day) and nerve root block with corticosteroids (1 mg/0.5 ml of betamethasone plus 0.5 ml of 1% lidocaine) provided only transient pain relief. Operative management with surgical discectomy was discussed. Anesthesiologists, obstetricians, and neonatologists were consulted for preoperative planning, focusing on appropriate anesthesia, ideal positioning for surgical access, and provision for emergent fetal care. Surgery was ultimately performed in the left lateral position, in contrast to the oft-used prone position. Micro-endoscopic discectomy was performed under general anesthesia at 24 weeks gestation.
The patient experienced complete relief from pain following surgical intervention and delivered a healthy baby at 39 weeks gestation following normal labor. Our methods, used in accordance with our preoperative simulation, resulted in a satisfactory outcome for both mother and child.
Although previously published cases noted the safety of operating in the prone position under epidural anesthesia, we performed minimally invasive micro-endoscopic discectomy in the left lateral position in combination with general anesthesia and found that this is a safe and preferable alternative for pregnant patients in the latter stage of the second trimester.
N/A.
This research output has an Altmetric Attention Score of 5. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 26 October 2017.
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#10,279,513
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#3,301
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Outputs of similar age
#139,279
of 470,745 outputs
Outputs of similar age from Spine
#47
of 116 outputs
Altmetric has tracked 34,410,315 research outputs across all sources so far. This one has received more attention than most of these and is in the 70th percentile.
So far Altmetric has tracked 10,027 research outputs from this source. They typically receive a little more attention than average, with a mean Attention Score of 7.2. This one has gotten more attention than average, scoring higher than 66% of its peers.
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We're also able to compare this research output to 116 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 59% of its contemporaries.
