妊娠中に坐骨神経痛で発症した腰椎椎間板ヘルニアに対し手術加療を行った1例

DOI

書誌事項

タイトル別名
  • A Case Report and Review of Surgical Treatment for a Lumbar Disc Herniation with Sciatica in Pregnancy

抄録

<p>  Use of drugs and radiological diagnoses are restricted for lumbar disc herniation during pregnancy. Fluoroscopy is avoided as much as possible. We report a case of lumbar disc herniation in a pregnant woman who underwent surgery.</p><p>  A 32-year-old woman, 16 weeks pregnant, who presented to an orthopedic clinic with left lower back and limb pain lasting for a month. Lumbar magnetic resonance imaging showed left posterolateral lumbar disc herniation at L5/S1. Conservative management failed, and she could not tolerate this uncontrollable intense pain until delivery ; therefore, the patient was referred to our department for surgery. She was not paralyzed but was unable to walk because of severe pain. The left straight leg raising test result was <30°. The preoperative Japan Orthopedic Association (JOA) score was 8/29. After consultation with an anesthesiologist and an obstetrician/gynecologist at our hospital, we decided to check the fetal heart sounds and echo findings before and after surgery. Surgery was performed under intravenous anesthesia using the standard Love’s method. The intraoperative position was prone on a four-point trestle table. The vertebral level was checked once, taking care not to irradiate the pelvic cavity. Postoperatively, the sciatica disappeared, the JOA score improved to 29 points, and the patient was discharged without symptoms on the eighth postoperative day.</p><p>  During pregnancy, radiation exposure must be avoided as much as possible, considering its influence on the fetus. As the weeks of pregnancy progress, surgery in the left lateral position is recommended to avoid elevating the intra-abdominal pressure or compressing the inferior vena cava. In our case, the patient’s body shape was almost the same as before she became pregnant. Therefore, we concluded the patient could undergo surgery in the prone position.</p><p>  In cases of herniated discs with severe pain that do not respond to conservative treatment, surgery is extremely useful and safe even during pregnancy.</p>

収録刊行物

  • 脊髄外科

    脊髄外科 38 (1), 61-65, 2024

    日本脊髄外科学会

詳細情報 詳細情報について

  • CRID
    1390300147451778304
  • DOI
    10.2531/spinalsurg.38.61
  • ISSN
    18809359
    09146024
  • 本文言語コード
    ja
  • データソース種別
    • JaLC
  • 抄録ライセンスフラグ
    使用不可

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