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European Spine Journal
Published in: European Spine Journal 4/2017

01-10-2017 | Review

How to treat lumbar disc herniation in pregnancy? A systematic review on current standards

Authors: Alberto Di Martino, Fabrizio Russo, Luca Denaro, Vincenzo Denaro

Published in: European Spine Journal | Special Issue 4/2017

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Abstract

Purpose

In this systematic review, we aim to illustrate the current and safe concepts in the assessment, diagnosis and management of herniated lumbar disc (HLD) during pregnancy.

Methods

A systematic review and reporting on the diagnosis, treatment and clinical results of HLD during pregnancy is performed.

Results

The MRI represents the first level and safest diagnostic tool for pregnant women affected by spinal problems allowing for a noninvasive and detailed radiological examination of the spine. The initial management of pregnant women affected by HLD is conservative, and primarily aimed to pain therapy. Whenever radicular pain and progressive neurological deficits unresponsive to medical management occur, surgery should be considered. Few case reports regarding the operative management of HLD in pregnant women have been published up to date. Laminectomy and/or microdiscectomy represent the classical and most commonly used techniques that can be safely performed without affecting pregnancy, delivery, or baby’s health. Endoscopic discectomy may be an alternative. The most adequate timing and surgical position are chosen based on to the fetal gestational age and site of the pathology.

Conclusions

Surgical treatments during pregnancy impose multiple medical and ethical problems. Timely diagnosis by MRI, careful clinical evaluation, and surgical treatment represent safe and effective procedures. Ongoing evolution of surgical, anesthesiological and obstetrical procedures results in favorable outcomes. However, interdisciplinary management and a wide knowledge of pregnancy-related pathologies are crucial for the best outcome for both mother and child.
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Metadata
Title
How to treat lumbar disc herniation in pregnancy? A systematic review on current standards
Authors
Alberto Di Martino
Fabrizio Russo
Luca Denaro
Vincenzo Denaro
Publication date
01-10-2017
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue Special Issue 4/2017
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-017-5040-8

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