Lumbar Disc Herniation and Cauda Equina Syndrome During Pregnancy: A Systematic Review.

Autor: Hussein A; Department of Neurosurgery, Banner University Medical Center Phoenix USA- University of Arizona, 1111 E McDowell Rd, Phoenix, AZ, 85006, USA. amna.s.hussein@gmail.com., Quiceno E; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA.; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA., Pacheco-Barrios N; Department of Neurosurgery, Banner University Medical Center Phoenix USA- University of Arizona, 1111 E McDowell Rd, Phoenix, AZ, 85006, USA., Dholaria N; Department of Neurosurgery, Banner University Medical Center Phoenix USA- University of Arizona, 1111 E McDowell Rd, Phoenix, AZ, 85006, USA., Pico A; Department of Neurosurgery, Banner University Medical Center Phoenix USA- University of Arizona, 1111 E McDowell Rd, Phoenix, AZ, 85006, USA., Barbagli G; Department of Neurosurgery, Banner University Medical Center Phoenix USA- University of Arizona, 1111 E McDowell Rd, Phoenix, AZ, 85006, USA., Kelbert J; Department of Neurosurgery, Banner University Medical Center Phoenix USA- University of Arizona, 1111 E McDowell Rd, Phoenix, AZ, 85006, USA., Soto-Rubio DT; Department of Neurosurgery, Banner University Medical Center Phoenix USA- University of Arizona, 1111 E McDowell Rd, Phoenix, AZ, 85006, USA., Alhalal IA; Department of Neurosurgery, Banner University Medical Center Phoenix USA- University of Arizona, 1111 E McDowell Rd, Phoenix, AZ, 85006, USA., Al-Arfaj AK; Department of Neurosurgery, Banner University Medical Center Phoenix USA- University of Arizona, 1111 E McDowell Rd, Phoenix, AZ, 85006, USA., Prim M; Department of Neurosurgery, Banner University Medical Center Phoenix USA- University of Arizona, 1111 E McDowell Rd, Phoenix, AZ, 85006, USA., Baaj AA; Department of Neurosurgery, Banner University Medical Center Phoenix USA- University of Arizona, 1111 E McDowell Rd, Phoenix, AZ, 85006, USA.
Jazyk: angličtina
Zdroj: Acta neurochirurgica [Acta Neurochir (Wien)] 2024 Nov 26; Vol. 166 (1), pp. 479. Date of Electronic Publication: 2024 Nov 26.
DOI: 10.1007/s00701-024-06377-4
Abstrakt: Introduction: Low back pain is common during pregnancy, affecting up to 76% of women. However, symptomatic lumbar disc herniation (LDH) is rare, occurring in about 1 in 10,000 pregnancies, with less than 2% progressing to cauda equina syndrome (CES). The overlap in symptoms between LDH and typical pregnancy-related conditions complicates both diagnosis and management. This review aims to enhance understanding of LDH and CES during pregnancy and provide a comprehensive overview of treatment options.
Methodology: A systematic review of the PubMed database was conducted following PRISMA guidelines, focusing on patient demographics, clinical presentation, diagnostics, treatment strategies, and outcomes.
Results: Thirty-three case reports and series involving 51 pregnant women diagnosed with LDH and CES were analyzed. The average age was 33.2 years, with most symptoms occurring in the third trimester. Lower extremity pain (86.3%) and low back pain (78.4%) were the predominant symptoms, with 49.0% experiencing sphincter involvement. MRI was the primary diagnostic tool, identifying single-level disc herniation in 92.2% of cases. Antepartum spine surgery was performed on 74.5% of the women, predominantly through microdiscectomy, with 79.2% using general anesthesia. Post-surgery, 52.6% had cesarean sections, while 42.1% delivered vaginally. Adverse events were minimal (3.9%), and 62.7% of patients experienced favorable outcomes without neurological deterioration or maternal/fetal deaths.
Conclusion: Although rare, acute LDH and CES during pregnancy require prompt attention and intervention. MRI and emergent surgical treatment are generally safe and effective for both mother and fetus. Special surgical positioning and anesthesia management considerations are critical to minimizing risks and ensuring favorable outcomes.
Competing Interests: Declarations. Ethical approval: Ethical approval was not required as this study is a systematic review of published data. Conflicts of interest: The authors declare no competing interests.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)
Databáze: MEDLINE
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