Is It Safe to Have Herniated Disc Surgery during Pregnancy?
Pregnancy brings many physical changes, and for some women, severe back pain from a herniated disc can make an already challenging time even more difficult. If you are experiencing debilitating pain from a herniated disc while you are pregnant, you may be wondering whether surgery is an option. In this article, we take a closer look at the complexities of herniated disc surgery during pregnancy, the risks involved, and the alternative treatments that can help you manage your pain safely.
Understanding Herniated Discs during Pregnancy
A herniated disc occurs when the soft, gel-like center of a spinal disc pushes through a tear in the outer layer, potentially pressing on nearby nerves. During pregnancy, several factors increase the risk of developing or exacerbating a herniated disc. The hormone relaxin, which prepares the body for childbirth by loosening ligaments, can also affect spinal stability. Additionally, weight gain and changes in posture shift your center of gravity forward, placing extra stress on the lower back.
The symptoms of a herniated disc can range from mild discomfort to severe radiating pain that travels down the legs, a condition known as sciatica. You might also experience numbness, tingling, or muscle weakness in the affected area. While these symptoms are certainly uncomfortable, they do not always necessitate surgical intervention, especially during pregnancy.
The Risks of Surgery during Pregnancy
Herniated disc surgery during pregnancy is generally avoided except in the most extreme circumstances. The primary concern is the safety of both mother and baby. Most herniated disc surgeries require general anesthesia, which carries risks during pregnancy, particularly during the first trimester when the baby’s organs are developing. Anesthetic agents can potentially affect fetal development, though the extent of risk depends on the specific medications used and the time of exposure.
Beyond anesthesia concerns, the surgical positioning required for spinal procedures can be problematic during pregnancy. Many herniated disc surgeries are performed with the patient lying face-down, which becomes increasingly difficult and potentially dangerous as pregnancy progresses. The pressure on the abdomen in this position could compromise blood flow to the uterus and the developing baby.
Radiation exposure from imaging techniques like fluoroscopy, commonly used during spinal surgery to guide instrumentation, presents another significant risk. While modern surgical techniques minimize radiation exposure, any amount during pregnancy requires careful consideration. The radiation could potentially harm the developing fetus, particularly during the first trimester.
When Surgery Might Be Considered
Despite the general preference to avoid surgery during pregnancy, there are rare situations when herniated disc surgery might be deemed necessary. These emergency situations typically involve progressive neurological deficits that threaten permanent damage. For example, cauda equina syndrome is a rare but serious condition where the herniated disc compresses the bundle of nerves at the base of the spine, potentially causing loss of bowel or bladder control, severe leg weakness, or saddle anesthesia (numbness in the inner thighs and buttocks).
In such cases, the risk of permanent neurological damage may outweigh the risks associated with surgery during pregnancy. However, these decisions are made on a case-by-case basis with input from your obstetrician, spine surgeon, and potentially a maternal-fetal medicine specialist. The medical team will carefully weigh the severity of your condition, your gestational age, and the potential risks to both you and your baby.
If surgery is absolutely necessary during pregnancy, the second trimester is generally considered the safest time. By this point, the baby’s major organs have formed, reducing the risk of developmental abnormalities from anesthesia. The uterus is also not yet large enough to cause significant complications with positioning during surgery.
Conservative Treatment Options
Fortunately, the vast majority of herniated discs during pregnancy can be managed conservatively without surgery. Physical therapy is often the first line of treatment and can be highly effective. A physical therapist experienced in treating pregnant women can teach you exercises to strengthen your core and back muscles, improve posture, and reduce pressure on the affected disc. These exercises are specifically designed to be safe during pregnancy and can provide significant relief.
Pain management during pregnancy requires special consideration, since many common pain medications are not recommended. Acetaminophen is generally considered safe throughout pregnancy and can help you manage mild to moderate pain. However, nonsteroidal anti-inflammatory drugs like ibuprofen are typically avoided, especially in the third trimester, due to potential effects on the baby’s heart and kidneys.
Epidural steroid injections, which are sometimes used to treat herniated discs in people who are not pregnant, are generally avoided during pregnancy due to the lack of safety data. However, in severe cases where the benefits might outweigh the risks, they may be considered under careful medical supervision.
Alternative Pain Relief Methods
Many pregnant women find relief through complementary approaches that do not involve medication or surgery. Prenatal massage, when performed by a therapist trained in pregnancy massage, can relieve muscle tension and increase circulation. The massage should be performed with you lying on your side with proper support rather than on your stomach.
Chiropractic care from a practitioner experienced in treating pregnant women can also provide relief. Chiropractors use special techniques and tables designed for pregnant women to avoid putting pressure on the abdomen while still allowing for spinal adjustments.
Heat and cold therapy can be effective for managing pain at home. Applying ice packs to the affected area for 15–20 minutes several times a day can reduce inflammation, while heat can relax tense muscles. Always place a cloth barrier between your skin and the ice or heat source to avoid burns or frostbite.
Supportive devices like maternity belts or pregnancy support bands can redistribute the weight of your growing belly and reduce strain on your lower back. These devices work by providing external support to your abdominal muscles and can make a significant difference in your daily comfort level.
Working with Your Healthcare Team
If you are dealing with a herniated disc during pregnancy, open communication with your healthcare providers is essential. Your obstetrician should be informed about your back pain and any treatments you are considering. They can coordinate your care and ensure any interventions are safe for your pregnancy.
You may also benefit from consulting with a spine specialist who has experience treating pregnant patients. They can assess the severity of your herniated disc, monitor for any concerning neurological symptoms, and help you develop a comprehensive conservative treatment plan.
Keep your healthcare team informed about changes in your symptoms, particularly if you experience sudden weakness in your legs, loss of bowel or bladder control, or severe pain that does not respond to conservative measures. These could be signs your condition requires more urgent attention.
Looking Ahead: Postpartum Considerations
The good news is that many women find their herniated disc symptoms diminish after delivery. The removal of the extra weight and pressure from pregnancy, combined with hormonal changes that allow ligaments to return to their normal state, can provide significant relief. However, if your symptoms persist or worsen after delivery, surgical options can be reconsidered without the complications of pregnancy.
While dealing with a herniated disc during pregnancy is undoubtedly challenging, surgery is rarely necessary. By working closely with their healthcare teams and exploring conservative treatment options, most women can effectively manage their symptoms and safely carry their pregnancies to term. Remember this difficult period is temporary, and many treatment options that are not suitable during pregnancy become available after your baby arrives.
If you are still experiencing back pain from a herniated disc after your baby is born, your doctor may recommend surgery to provide relief. For example, if your herniated disc is not responding to conservative treatment, a discectomy or microdiscectomy may be the best option. Although this is generally a very successful procedure, patients with a large hole in the outer ring of the disc have a significantly higher risk of reherniation following surgery. Often, the surgeon will not know the size of the hole until beginning surgery, and having a large hole in the outer ring of the disc more than doubles the risk of needing another operation. A new treatment, Barricaid, is a bone-anchored device designed to close this hole, and 95 percent of Barricaid patients did not undergo a reoperation due to reherniation in a 2-year study timeframe. This treatment is done immediately following the discectomy—during the same operation—and does not require any additional incisions or time in the hospital.
If you have any questions about the Barricaid treatment, ask your doctor or contact us directly.
For full benefit/risk information, please visit: https://www.barricaid.com/instructions.
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