European Spine Journal

, Volume 27, Supplement 3, pp 483–488 | Cite as

Surgical management of cauda syndrome in third trimester of pregnancy focusing on spinal anesthesia and right lateral positioning during surgery as possible practices

  • Viktor Zsolt KovariEmail author
  • Laszlo Horvath
Case Report



This article presents a surgical solution of a lumbar disc hernia of a pregnant woman focusing on the use of right lateral positioning, spinal anesthesia which has not previously been utilized in third trimester and discusses positioning options, and possible anesthesia methods with the surgical procedure options.


Case report.


A left-sided L5/S1 lumbar disc hernia (verified by magnetic resonance imaging) of a 35-year-old, 32-week-pregnant woman with a deteriorating neurological status leading to cauda syndrome was treated successfully by microdiscectomy in right lateral position applying spinal anesthesia.


So far examples are given for almost every possible patient position in the third trimester except the right lateral one. All the previously presented positionings (prone, left lateral) were equally effective regarding the outcome with none being better than another. For left-sided lumbar pathologies performed in the third trimester the right lateral position might be an alternative option for easier access. Based on the literature an epidural and general anesthesia can be applied successfully in the third trimester. Spinal anesthesia might be another anesthesia consideration.


Lumbar disc herniation Pregnancy Cauda syndrome Spinal anesthesia Right lateral position 


Compliance with ethical standards

Conflict of interest

Viktor Zsolt Kovari and Laszlo Horvath declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurosurgeryHungarian Defense Forces Medical CentreBudapestHungary
  2. 2.Department of Anesthesiology and Intensive CareHungarian Defense Forces Medical CentreBudapestHungary

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