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.

BACKGROUND: 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.

CASE REPORT: A 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.

CONCLUSION: Our 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.