Chan Nanette Y, Le Michael, Reinecker Sophie, Prince Morgan, Murphy Geoffrey T
Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
J Spine Surg. 2024 Jun 21;10(2):274-285. doi: 10.21037/jss-24-3. Epub 2024 Jun 13.
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.
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.
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% 50%) and lower rates of cesarean section (57% 70%) compared to surgical management. Among surgically treated patients, microdiscectomy showed higher symptom resolution (59%) compared to laminectomy (17%) or a combined approach (33%).
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.
孕期背痛很常见,但孕期腰椎间盘突出引起的疼痛却很少见。本系统评价旨在全面分析关于孕期腰椎间盘突出的文献,重点关注危险因素、发病率、临床表现和治疗方法。
我们使用PubMed和Web of Science数据库进行文献综述,纳入1950年1月1日至2023年8月1日的研究。采用队列研究的批判性评估技能计划(CASP)清单和病例对照研究的乔安娜·布里格斯研究所批判性评估清单来评估偏倚风险。该综述方案此前未发表。
共审查了41项研究,其中6项涉及发病率和危险因素,35项关注临床表现和治疗方法。发现孕期有症状的腰椎间盘突出并不常见,根据磁共振成像(MRI)结果,孕期未发现明显的易患因素。然而,MRI检测到有椎间盘突出的患者更有可能报告背痛。与手术治疗相比,非手术治疗导致症状完全缓解的比例更高(69%对50%),剖宫产率更低(57%对70%)。在接受手术治疗的患者中,与椎板切除术(17%)或联合手术(33%)相比,显微椎间盘切除术的症状缓解率更高(59%)。
虽然怀孕本身不会增加腰椎间盘突出的风险,但椎间盘突出的存在可能导致孕期背痛。现有证据质量较差,应谨慎解读。在没有包括肠道和膀胱功能障碍在内的警示症状的情况下,可以尝试非手术治疗,其症状缓解效果相对较好。此外,在本研究范围内,必要时进行手术治疗与妊娠并发症没有明确关联。