Alberto Di Martino1, Fabrizio Russo2, Luca Denaro3, Vincenzo Denaro2. 1. Department of Orthopedics and Trauma Surgery, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy. dimartino.cbm@gmail.com. 2. Department of Orthopedics and Trauma Surgery, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy. 3. Cattedra di Neurochirurgia, Dipartimento di Neuroscienze, Università di Padova, Padua, Italy.
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.
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.
Entities:
Keywords:
Conservative treatment; Diagnostic imaging; Lumbar disk herniation; Pregnancy; Surgery
Authors: M De Santis; E Di Gianantonio; G Straface; A F Cavaliere; A Caruso; F Schiavon; R Berletti; M Clementi Journal: Reprod Toxicol Date: 2005 Sep-Oct Impact factor: 3.143
Authors: A Splendiani; F D'Orazio; L Patriarca; F Arrigoni; F Caranci; P Fonio; L Brunese; A Barile; E Di Cesare; C Masciocchi Journal: Musculoskelet Surg Date: 2017-02-06