Low back pain is a common complaint in pregnancy reported by over 50% of patients, however disc herniation is rare, affecting 1:10,000 pregnancies. Providers must be able to recognize severe and progressive neurological symptoms, like cauda equina syndrome, to prevent long-term sequelae. There are no other cases reported of a vaginal delivery as soon as 6 weeks after spinal surgery.METHODS:
A 32 yo G4P2 with longstanding back pain developed L5-S1 disc displacement at 32 weeks gestation. Due to progressive neurological dysfunction, she underwent bilateral hemilaminectomy and foraminotomy with L5-S1 discectomy under general anesthesia in the prone position. Her obstetrician scheduled her primary cesarean delivery at 39 weeks due to her spinal surgeon's concern of damaging her recent surgery. She had a precipitous vaginal delivery 1 day prior to her scheduled cesarean and 6 weeks after her surgery. Her back pain symptoms began to return 4 days postpartum and necessitated repeat surgery 4 weeks after delivery due to recurrent L5-S1 disc herniation and lower extremity radiculopathy.CONCLUSION:
Data is lacking on the best mode of delivery on patients who have undergone spinal surgery. There are no case reports of vaginal delivery after a spinal surgery as recent as the third trimester. It is unclear whether vaginal delivery was the cause of reherniation in our case report. Cesarean delivery is not necessarily protective as demonstrated by a case report of herniation after scheduled cesarean delivery. We recommend a multidisciplinary team approach to manage patients on a case-by-case basis.