Back Surgery During Pregnancy Gets the OK--If It's an EmergencyWhen a disc in a person's lower back becomes herniated, it can put pressure on the joints, ligaments, and nerves of the low back. In some cases, the pressure is so bad that it can cause pain and numbness in the pelvis, low back, and down one or both legs. It can also result in a condition called cauda equina syndrome, which causes serious problems with bladder and bowel control.
While about 56% of women have low back pain during pregnancy, only about one in 10,000 pregnant women actually shows symptoms from a disc herniation. In rare cases, the symptoms from a herniated disc require immediate back surgery. Putting surgery off can mean the pain, numbness, and incontinence become permanent. But what if the patient is pregnant? Is lumbar surgery safe during pregnancy?
These authors reviewed available medical literature. They also reported on three case studies of their own patients. The three women were in their first pregnancies when they developed symptoms of numbness or pain in one or both legs. One woman also had cauda equina syndrome. The women were all between 16 and 20 weeks into their pregnancies when they sought care for their symptoms.
In all three cases, lumbar surgery was successful. All the patients reported having fewer symptoms after surgery. And all three of their babies were born healthy and on time. The woman with cauda equina syndrome had been having symptoms for six weeks before she had surgery, and she continued to have some problems with constipation and incontinence, although she was much improved. The other two women made full or nearly full recoveries.
Based on their research and the case studies, the authors conclude that MRI scans, epidural and general anesthesia, and lumbar disc surgery can be done safely during pregnancy. The surgery should only be used when other types of care aren't working or in an emergency--such as cauda equina syndrome. The authors also recommend using a special four-poster frame that allows the woman to lie face-down during surgery without putting any pressure on the uterus or developing baby.
Mark D. Brown, MD, PhD, and Allan D. O. Levi, MD, PhD. Surgery for Lumbar Disc Herniation During Pregnancy. In Spine. February 15, 2001. Vol. 26. No. 4. Pp. 440-443.
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