The surgical plan and the
anesthetic approach are vital in determining the proper treatment of lumbar
disc herniation in pregnancy. The diagnostic tools available, as well as the
anesthetic agents and methods of delivery, vary in pregnant patients due to factors such as radiation exposure and hemodynamics in the patient and fetus. The gestational age also plays an important role in determining treatment options. When possible, surgery should be avoided during the first trimester, especially during the period of organogenesis, as
general anesthesia can interfere with this process. However, when focal neurological deficits are present, urgent
surgical decompression may be necessary. In such cases, the selection of
anesthesia must be guided by maternal indications and the nature of the surgery. Maternal safety and avoidance of
fetal hypoxia and subsequent
preterm labor are crucial when pregnant patients receive
anesthesia. As a result,
local anesthesia is often preferred when possible due to the decreased risk of systemic toxicity.
Decompression surgery in pregnant females with lumbar
disc herniation, using a multidisciplinary approach among the surgeon, obstetrician, and anesthesiologist, is an effective and safe procedure for both the mother and the fetus. We present the case of a pregnant female at four weeks of gestation who presented with
lower back pain radiating down her right leg. MRI of the lumbar spine showed large L4-5
disc herniation. She underwent a successful right L4-5 microdiscectomy under
local anesthesia and spinal block using
bupivacaine and was completely awake throughout the procedure. Postoperatively, she experienced immediate improvement of symptoms.