The Management of Symptomatic Lumbar Disc Herniation in Pregnancy: A Systematic Review

Abstract

Study Design: Systematic review. Objectives: Lumbar disc herniation (LDH) has been reported to affect 1 in 10 000 pregnant women. There is limited evidence available regarding the optimal management of LDH in pregnant patients. We aimed to review the current evidence for the management of symptomatic LDH in pregnancy through critical appraisal and analysis of the available literature. Methods: Searches were conducted in Medline, Embase, PubMed, Science Direct, and The Cochrane Library from inception using predetermined search terms. All peer-reviewed studies of pregnant women with symptomatic LDH were included. The quality of eligible articles was assessed and extracted data and characteristics were pooled for analysis. References cited by studies were screened to identify other relevant publications. Results: Thirty studies involving 52 patients were identified. Compared to surgically managed patients, conservatively managed patients had a higher full recovery rate (61.54% vs 56.41%) and reported a lower rate of persistent symptoms (30.77% vs 38.54%). Compared to patients who were treated surgically for cauda equina syndrome, patients treated surgically for sciatica had a higher full recovery rate (80.95% vs 27.78%) and reported a lower rate of persistent symptoms (14.29% vs 66.67%). Conclusion: There is limited evidence to guide the management of pregnant patients with LDH. Despite a suggestion toward improved outcomes with conservative management, the presence of selection bias and the overall poor quality of current research precludes reliable conclusions from being drawn. Decision making for this patient group should be undertaken within a multidisciplinary setting.

Clinical comparison of unilateral biportal endoscopic discectomy with percutaneous endoscopic lumbar discectomy for single l4/5‐level lumbar disk herniation

“…For the spinal surgical treatment, the most critical determining factor is adequate decompression. 13 Compared with conservative treatment, no matter what surgical method to the treatment of LDH, part of the lamina and facet joints must be removed, which is bonded to destroy the stability of the spine, and even it could damage the dural sac and nerve root, resulting in serious surgical complications. To protect the posterior stabilizing structures and ensure the safety of operation, the most classical technology used for bilateral decompression was unilateral laminotomy.…”

Non-obstetric Causes of Cesarean Section in Iranian Pregnant Women Referring to Medical Services Commission

“…Although women with normal deliveries do not report high rates of persistent neurological symptoms, some doctors recommend that women have CS to prevent the worsening of lumbar spine symptoms. Labor induction before LDH treatment can increase nerve damage due to increased epidural venous pressure occurring during labor (31,32).…”

Caesarean Section for Orthopedic Indications

“…A review by Paslaru F.G. et al analyzed 30 studies involving 52 patients [32] in which conservative treatment was associated with better long-term therapeutic effects compared to surgical treatment [32]. Although pregnancy itself is not a contraindication to surgical treatment of LDH at any stage of its duration [33], the most frequently chosen treatment method is conservative treatment until delivery [34,35]. There are various conservative treatments that can provide relief from herniated disc pain during pregnancy such as physical therapy, acupuncture, heat and ice therapy, prenatal massage, transcutaneous electrical nerve stimulation (TENS) units.…”