Pregnancy is a delicate time to have injuries or illnesses. On the one hand, we are limited in the medical tests we can perform and, on the other hand, there are also treatments that can put the baby at risk. Every pregnant woman knows that there are medicines that she should not take to avoid harming the baby. Sometimes surgery may be necessary and these have their own considerations. The herniated disc is a rare cause of surgery during pregnancy but it can occur.
The back pain is common during pregnancy and sometimes the cause is a herniated disc. The herniated disc can cause pain, either lumbar or even sciatic, but usually does not give complications. In exceptional cases it can complicate the situation and injure a motor nerve root, for example. In these cases, the need to operate the hernia may be considered despite pregnancy.
How is a herniated disc diagnosed in pregnancy?
During pregnancy, tests are avoided unless strictly necessary. This is especially true of those who produce radiation such as X-rays and TAC (scanner). No imaging is necessary to assess low back pain. Physical exploration leads to the most important conclusions. If a complication is suspected to require surgery, such as the paralysis of a muscle, then the cause must be seen.
The cause can be confirmed by performing an MRI. This test has no radiation, unlike the previous ones, and will give us the information we need. In principle it is safe to perform this test in pregnancy, provided that no contrasts are used. It is still recommended to avoid it during the first trimester.
When should a herniated disc be operated during pregnancy?
The indication to operate would really be the same as that of a person who is not pregnant. It arises mainly in the case of neurological complications. In the case of crippling pain without neurological deficit, it would have to be weighed. Although the indications are the same, the decision takes into account certain aspects related to the pregnancy itself.
The best time to perform the intervention would be the second quarter, by consensus, when it is understood that there are fewer risks. Above all, avoid operating in the first quarter. If the pregnancy is near the end it can be considered to advance the delivery, if it is viable.
How is the herniated disc surgery done in pregnancy?
Open micro discectomy is the technique preferred by surgeons for these cases. There is one published case of successful endoscopic surgery. That could be an advantage because of the less aggression it entails.
When operating a herniated disc the position in the operating room varies depending on the technique and the preferences of the surgeon. When the patient is pregnant, the position in the operating room will vary according to the weeks of gestation, seeking to minimize the risks for the mother and the fetus. From the second half of the second trimester (weeks 18 to 20) the patient lies on her side to avoid complications. In the third trimester only on the left side.
Is the baby at risk for the operation?
Logically a surgery has its risks, both for the anesthesia and for the surgery itself. This makes it necessary to avoid surgery whenever possible. One tries to limit the surgeries to the essential ones by a question of survival fundamentally, as can be appendicitis, for example.
Lumbar surgery is not a life or death issue but there will be occasions where the benefit we are going to get outweighs the risks. In the case of the herniated disc neurological complications can be a good reason, especially the ponytail syndrome.
There are studies that evaluate the results after surgeries performed during pregnancy. These studies took into account all types of non-gynecological surgeries. Some conclusions were reached. In pregnant women undergoing surgery, there is no higher rate of congenital anomalies. There seems to be a higher rate of low birth weight in these patients. It also appears that there may be more deaths during the first week of the baby’s life than in the non-operated ones. It should be noted that these data refer to surgeries of all types such as cardiac and abdominal (eg appendicitis, gallbladder). There are no specific data on lumbar surgery.
In summary, surgery should be avoided at all costs during pregnancy but, if it is essential due to neurological complications, it can be performed with risks acceptable for the mother and the baby.