Lee Jae Meen, Han In Ho, Moon Soo Hyeon, Choi Byung Kwan
Department of Neurosurgery, Pusan National University School of Medicine, Busan, Korea.
Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan, Korea.
Korean J Spine. 2011 Dec;8(4):304-6. doi: 10.14245/kjs.2011.8.4.304. Epub 2011 Dec 31.
A few cases of lumbar disc herniation (LDH) that have been treated by surgery during pregnancy have been reported in the literature. However, symptomatic recurrent LDH during pregnancy has been rarely reported. A 32-year-old parous woman presented with lumbago and severe right leg pain at 20 weeks' gestation. Eleven years prior to admission, she had undergone an open discectomy for right-sided LDH at the L4-5 level. Magnetic resonance imaging (MRI) showed a recurrent disc herniation that affected the nerve root at the right L4-5 level. The radiating pain did not respond to conservative treat-ment. Revision surgery was performed under general anesthesia and in the left lateral position to avoid fetal stress and aortocaval compression, and the ruptured disc particle was completely removed. Postoperatively, the radiating pain was completely relieved. She delivered a full-term healthy girl (birth weight, 3.39 kg) at 40 weeks' gestation by normal vaginal delivery. We report the rare case of a 32-year-old parous woman with recurrent LDH that was successfully treated by revision surgery. In recurrent LDH patients with incapacitating pain who do not respond to opioid injections, surgical treat-ment could lead to a satisfactory outcome maintaining pregnancy.
文献中已报道了几例在孕期接受手术治疗的腰椎间盘突出症(LDH)病例。然而,孕期症状性复发性LDH鲜有报道。一名32岁经产妇在妊娠20周时出现腰痛和严重的右腿疼痛。入院前11年,她因L4 - 5节段右侧LDH接受了开放性椎间盘切除术。磁共振成像(MRI)显示复发性椎间盘突出,影响右侧L4 - 5节段神经根。放射性疼痛对保守治疗无效。在全身麻醉下并采取左侧卧位进行翻修手术,以避免胎儿受压和主动脉腔静脉受压,破裂的椎间盘颗粒被完全清除。术后,放射性疼痛完全缓解。她在妊娠40周时通过正常阴道分娩产下一名足月健康女婴(出生体重3.39 kg)。我们报告了一例罕见的32岁经产妇复发性LDH病例,该病例通过翻修手术成功治疗。对于对阿片类注射无反应的、伴有失能性疼痛的复发性LDH患者,手术治疗可带来维持妊娠的满意结果。