Neurosurgery for a Herniated Disk Put the Safety of Mom and Baby First
By Fiona Phelan
Published August 07, 2025
Drs. Jacky Yeung and Sarah Cross collaborated on a case that helped a pregnant mother relieve severe back pain with minimally invasive awake endoscopic spine surgery during the mother’s second trimester.
When 37-year-old Sarah Howe awoke one morning with excruciating back pain during her first trimester, she knew she had to find relief. The pain was so severe that she was bed-ridden for several weeks. An MRI revealed a large, herniated disc compressing one of her spinal nerves – an issue that could not wait until after delivery.
“I could barely move. I couldn’t sit in the car, I couldn’t drive. It was awful,” Howe said.
Howe faced a daunting challenge: how to relieve her debilitating pain without putting her unborn baby at risk. After consulting with a multidisciplinary team at L+M Hospital that included Neurosurgeon Jacky Yeung, MD, assistant professor of Neurosurgery at Yale School of Medicine; and Sarah Cross, MD, chair of Obstetrics, Gynecology and Reproductive Sciences, associate professor of Ob/Gyn and reproductive services at Yale School of Medicine, Howe was presented with a promising option: awake endoscopic spine surgery.
Dr. Sarah CrossThe procedure, performed under local anesthesia, allowed Dr. Yeung to remove the herniated disc while minimizing risk to the baby. Throughout the surgery, Howe was able to communicate with her care team.
Dr. Yeung explained the procedure: “We used a very, very small incision, less than a centimeter, in order to put in a small camera that allows us to bypass muscles in the back, minimizing the potential for damage and allowing me to work around the nerves, and very delicately remove the disk herniation.”
Just hours after surgery, Howe reported immediate relief from her pain. She was up, discharged from the hospital, and walking the same day, and a few months later, she delivered a healthy baby boy.
In addition to the local anesthesia, advantages of Howe’s awake endoscopic surgery included no need for opioids, faster recovery and a quicker return to daily life without pain.
Dr. Cross said communication between teams was outstanding throughout Howe’s case. “It always takes special planning to perform surgery on someone who is pregnant, so I was very glad that Dr. Yeung called me to talk about the case,” Dr. Cross said. “It takes coordination among the surgeon, the anesthesiology team, the Ob/Gyn team and also Nursing.”
Dr. Yeung agreed. “Sarah’s surgery was unique because she was in her second trimester, so, in a way, I wasn't dealing with just one patient, I was dealing with two patients,” he said. “I had to worry about mom and also the baby. My focus was on her comfort and the overall safety of both mom and baby.”
