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Review
. 2024 Jun 21;10(2):274-285.
doi: 10.21037/jss-24-3. Epub 2024 Jun 13.

Lumbar disk herniation in pregnancy: its incidence, presentation and management: a systematic review

Nanette Y Chan  1   2 , Michael Le  1 , Sophie Reinecker  3   4 , Morgan Prince  3   4 , Geoffrey T Murphy  1   3
Affiliations
Review

Lumbar disk herniation in pregnancy: its incidence, presentation and management: a systematic review

Nanette Y Chan et al. J Spine Surg. .

Abstract

Background: Back pain in pregnancy is common, but pain from lumbar disk herniations in pregnancy is rare. This systematic review aims to comprehensively analyse literature on lumbar disk herniation in pregnancy, focusing on risk factors, incidence, clinical presentation, and management.

Methods: We conducted a literature review using PubMed and Web of Science databases, including studies from January 1, 1950, to August 1, 2023. The Critical Appraisal Skills Programme (CASP) checklist for cohort studies and the Joanna Briggs Institute Critical Appraisal Checklist for case-control studies were utilised to assess risk of bias. The review protocol was not previously published.

Results: A total of 41 studies were reviewed, with 6 addressing incidence and risk factors and 35 focusing on clinical presentation and management. Symptomatic lumbar disk herniation during pregnancy was found to be uncommon, with no significant predisposition noted during pregnancy as per magnetic resonance imaging (MRI) findings. However, patients with MRI-detected herniations were more likely to report back pain. Non-surgical management resulted in higher rates of complete symptom resolution (69% vs. 50%) and lower rates of cesarean section (57% vs. 70%) compared to surgical management. Among surgically treated patients, microdiscectomy showed higher symptom resolution (59%) compared to laminectomy (17%) or a combined approach (33%).

Conclusions: While pregnancy does not inherently increase the risk of herniated lumbar disks, the presence of a prolapsed disk can predispose to back pain during pregnancy. There is poor quality evidence that should be interpreted cautiously. Non-surgical management, in the absence of red-flag symptoms including bowel and bladder dysfunction may be trialled and yield comparatively better symptom resolution. Additionally, surgical management if necessitated has no clear link to pregnancy complications within the scope of this study.

Keywords: Pregnancy; disk; herniation; lumbar.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jss.amegroups.com/article/view/10.21037/jss-24-3/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Search strategy used to select the included studies.
Figure 2
Figure 2
Percentage of each respective symptom reported by women with a symptomatic lumbar disk herniation during pregnancy at presentation (n=48).
Figure 3
Figure 3
Percentage of non-surgically managed pregnant women with symptomatic lumbar disk herniations (n=4 for neurological symptoms and n=22 for pain) with the respective symptoms at initial presentation (blue) and final follow-up (orange).
Figure 4
Figure 4
Percentage of surgically managed pregnant women with symptomatic lumbar disk herniations (n=42) with the respective symptoms at presentation (blue) and final follow-up (orange).
Figure 5
Figure 5
Presenting symptoms (A) and symptoms at final follow-up (B) based on surgery type—microdiscectomy (blue), laminectomy (orange) and combined (grey).
See this image and copyright information in PMC

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