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Surgical Management of Lumbar Disc Herniation in Late Pregnancy Under General Anesthesia in the Prone Position: A
Kohei Okuyama1,2, Masahiro Inoue1, Mai Shimizu3
1Orthopaedic Surgery, Chiba University, Chiba, JPN.
Symptomatic lumbar disc herniation during pregnancy is rare, and surgery in the prone position during late pregnancy is challenging because of the risk of abdominal and aortocaval compression. A 42-year-old woman at 32 weeks of gestation presented with severe bilateral buttock pain, left radiculopathy, perineal sensory disturbance, and later bladder and bowel dysfunction due to L4-5 lumbar disc herniation. Emergency posterior lumbar discectomy was performed under general anesthesia in the prone position. A four-point support table combined with hammock-style abdominal suspension using elastic bandages and stockinettes allowed abdominal decompression and continuous cardiotocography monitoring. Her leg pain improved after emergence from anesthesia, and fetal status remained stable. She later delivered a healthy boy. Prone-position lumbar surgery may be considered in selected patients during late pregnancy when abdominal compression is avoided, fetal monitoring is maintained, and emergency obstetric intervention is available.
Symptomatic lumbar disc herniation during pregnancy is rare, and surgery in the prone position during late pregnancy is challenging because of the risk of abdominal and aortocaval compression. A 42-year-old woman at 32 weeks of gestation presented with severe bilateral buttock pain, left radiculopathy, perineal sensory disturbance, and later bladder and bowel dysfunction due to L4-5 lumbar disc herniation. Emergency posterior lumbar discectomy was performed under general anesthesia in the prone position. A four-point support table combined with hammock-style abdominal suspension using elastic bandages and stockinettes allowed abdominal decompression and continuous cardiotocography monitoring. Her leg pain improved after emergence from anesthesia, and fetal status remained stable. She later delivered a healthy boy. Prone-position lumbar surgery may be considered in selected patients during late pregnancy when abdominal compression is avoided, fetal monitoring is maintained, and emergency obstetric intervention is available.
