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

Int J Surg Case Rep. 2014;5(12):1178-82. doi: 10.1016/j.ijscr.2014.10.055. Epub 2014 Nov 7.

Abstract

Introduction: Low back pain is common during pregnancy. However, the incidence of symptomatic lumbar disc herniation during pregnancy is very rare. We report a case of lumbar disc herniation underwent discectomy just after cesarean delivery in the third trimester of pregnancy.

Presentation of case: A 33-year-old woman presented at 32 weeks gestation. She had a low back pain and the left-sided leg pain below the knee. At 34 weeks gestation, she had severe weakness of the left extension halluces longus, left ankle dorsiflexion. MRI showed a large disc herniation at L4/5 expanded to the spinal canal more. The cesarean delivery was performed in the supine position. The patient was then turned to a prone position, and a left L4/5 discectomy was performed. But the day after surgery, she had a severe low back pain and the right leg pain below the knee. MRI showed a disc herniation at L4/5 on the right side of the spinal canal. At 6 days after the first surgery, a right L4/5 discectomy was performed. In the immediate postoperative period, the patient experienced complete relief of the right leg pain.

Discussion: It is necessary to cooperate with a pediatrician, an obstetrician, and an anethesiologists. For obtaining the best outcome on mother and child, it is important to discuss in advance to be able to respond quickly for changeable situation.

Conclusion: It is necessary to conduct the operation under pregnancy in consideration of the great influence on mother and child.

Keywords: Cesarean delivery; Discectomy; Lumbar disk herniation; Prone position; Supine position; Trimester of pregnancy.