Awake micro-endoscopic discectomy without fluoroscopy performed in a 14-week pregnant lady in lateral decubitus position and use of gadolinium-soaked gauze to mark surgical incision: a case report and review of literature.
Case Report
Severe lumbar radiculopathy pain during pregnancy requiring surgical intervention poses significant risks to foetal and maternal health from use of potentially teratogenic general anaesthetic drugs, prone positioning and intra-operative radiation from fluoroscopy./r/nA 28-year-old 14 weeks primigravida patient suffering from severe lumbar radiculopathy due to right sided L5-S1disc herniation was offered a discectomy procedure after failed conservative treatment. A multidisciplinary team including anaesthetists, gynaecologist, radiologist and spine surgeon was constituted. A novel two-tier marking technique utilizing ultrasonography and magnetic resonance imaging (MRI) was used to accurately plan the L5-S1 surgical incision. The surgery was performed under spinal anaesthesia in left lateral decubitus position to avoid pressure on foetus and inferior vena cava. A tubular minimally invasive approach was used to access the L5-S1 disc. No intra-operative fluoroscopy marking was used. Post-operatively patient reported complete relief from radiating right leg pain and MRI confirmed adequate nerve decompression. Post-operative foetal scans were performed at regular intervals which were normal. Patient delivered a normal term baby girl without any complications./r/nOur two-tier marking technique and use of regional anaesthesia in lateral decubitus position avoids potentially teratogenic general anaesthetic agents and intra-operative radiation. It can be used to effectively decompress lumbar spine disc herniation and represents an advancement in ensuring safe spine surgery in pregnant females.
