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

다국어 초록 (Multilingual 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, 3.39kg) 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.

참고문헌 (Reference)

1 Dewing CB, "The outcomes of lumbar microdiscectomy in a young, active population: correlation by herniation type and level" 33 : 33-38, 2008

2 Brown MD, "Surgery for lumbar disc herniation during pregnancy" 26 : 440-443, 2001

3 Heaman MI, "Risk factors for spontaneous preterm birth among Aboriginal and non-Aboriginal women in Manitoba" 19 : 181-193, 2005

4 Weinreb JC, "Prevalence of lumbosacral intervertebral disk abnormalities on MR images in pregnant and asymptomatic nonpregnant women" 170 : 125-128, 1989

5 Mousavi SJ, "Pregnancy related pelvic girdle pain and low back pain in an Iranian population" 32 : E100-104, 2007

6 LaBan MM, "Pregnancy and the herniated lumbar disc" 64 : 319-392, 1983

7 한인호, "Pregnancy and spinal problems" Lippincott Williams & Wikins 22 : 477-481, 2010

8 Smith MW, "Orthopedic issues in pregnancy" 63 : 103-111, 2008

9 Vougioukas VI, "Neurosurgical interventions during pregnancy and the puerperium: clinical considerations and management" 146 : 1287-1291, 2004

10 Pike IL, "Maternal stress and fetal responses: evolutionary perspectives on preterm delivery" 17 : 55-65, 2005

11 Kathirgamanathan A, "Lumbar disc surgery in the third trimester--with the fetus in utero" 15 : 181-182, 2006

12 Pietila TA, "Lumbar disc herniation in patients up to 25 years of age" 41 : 340-344, 2001

13 Parisini P, "Lumbar disc excision in children and adolescents" 26 : 1997-2000, 2001

14 Brown MD, "Lumbar disc excision and cesarean delivery during the same anesthesia. A case report" 86 : 2030-2032, 2004

15 Katz JD, "Fetal heart rate monitoring in pregnant patients undergoing surgery" 125 : 267-269, 1976

16 Hyeun Sung Kim, "Endoscopic Discectomy for the CaudaEquina Syndrome During Third Trimesterof Pregnancy" 대한신경외과학회 42 (42): 419-420, 2007

17 Parrish KM, "Effect of changes in maternal age, parity, and birth weight distribution on primary cesarean delivery rates" 271 : 443-447, 1994

18 Han IH, "Clinical approach and surgical strategy for spinal diseases in pregnant women - A report of ten cases" LIPPINCOTT WILLIAMS & WILKINS 33 (33): E614-E619, 200801