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

Abstract

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.

Keywords: Antepartum Spine Surgery; Cauda Equina Syndrome (CES); Lumbar Disc Herniation (LDH); Maternal and Fetal Outcomes; Obstetric Neurological Complications; Pregnancy-Related Spine Surgery.