NONOBSTETRIC SURGICAL PROCEDURE IN PREGNANCY: MICRODISCECTOMY FOR ACUTE BACK PAIN

No conflicts of interest No funding obtained Background Acute herniated lumbar disc presented with significant neurological symptoms during pregnancy is extremely rare. Management of Disc herniation during pregnancy is also very complex. Method We report a 30-year-old woman at 17 weeks' gestation presented with lower back pain and left leg radicular symptoms, initially raising concerns for clots in the leg due to relevant family history. Doppler revealed no clots; subsequently, She found to have a large disc herniation at the L4-5 spinal level, resulting in nerve compression on MRI. An epidural corticosteroid injection was given as initial pain management, which only provided temporary pain alleviation and concerns that cauda equina may develop remained. Hence, the neurosurgical and obstetric teams agreed that surgical management would be appropriate; therefore, lumbar discectomy was successfully performed within 1 month of initial presentation without complications. Result In this case, microdiscectomy during antenatal period provided significant benefits by preventing progression to cauda equina by decompression of the nerve root while also minimising exposure to medications that could adversely affect foetal development. Conclusion Management of disc herniation during pregnancy involves both non-surgical and surgical approaches. Conservative procedures include physiotherapy, steroid injections, and selected analgesics. However, these measures may not provide expected sustained results as proven by this case; therefore, surgical intervention is necessary when symptoms persist with the risk of neurological compromise. Lumbar discectomy during the second trimester, in pregnancy is considered relatively safe with minimal maternal and risk when carefully considered.