A very rare case of cauda equina syndrome due to lumbar disc prolapse in a pregnant woman in the second trimester

Low back pain is a frequently encountered issue in pregnant women affecting >50%; incidence of low back pain secondary to lumbar disc herniation in pregnancies is low (1:10000). Cauda equina syndrome from lumbar disc herniation is a serious complication; delay in diagnosis and treatment can be a cause of chronic disability secondary to neurological sequelae. Numerous cases of disc herniation in pregnancy have been reported; however, cauda equina syndrome as a result of disc herniation is rare (2%). Here we are reporting a rare case of cauda equine syndrome in a pregnant woman at 16-week gestation is presented. We present a rare case of 30-year-old woman (G3P2L0) at 16-week gestation, presented initially at an emergency department at a district level hospital with low backache radiating to both the lower limbs treated with pain medications; 48 h later, the patient presented to us with bilateral foot drop with saddle anesthesia, urinary and fecal incontinence. On physical examination, the patient has bilateral foot drop with complete weakness of extensor hallucis longus and ankle inversion of both feet. The lumbar magnetic 'g (MRI) scan showed massive central disc herniation in L4–L5 level with severe central canal stenosis. After assessment by the anesthesiology and gynecology departments using a posterior approach under prone position, bilateral laminotomy and discectomy was performed at L4-L5 level. No complications were observed in the mother and the fetus during and after the surgery. Pain has subsided immediate post-op, three months after surgery, the patient was walking normally with minimal saddle hypoesthesia. The pregnancy proceeded normally, and she gave birth for full-term baby without any complications delivered by cesarean section. Clinical picture of low back pain is very frequent during pregnancy. However, we should perform an MRI scan for sudden onset of sciatica associated with loss of strength, bowel, and bladder disturbance. Patient diagnosed with cauda equina syndrome should undergo emergency surgery to minimize neurological sequelae.