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Management of Herniated Lumbar Disk Disease and Cauda Equina Syndrome in Pregnancy

Ahern, Daniel P. MBBCh, BAO*,†; Gibbons, Denys MBBCh, BAO*; Johnson, Gillian P. PhD; Murphy, Timothy M. MBBCh, BAO, BMedSc, FRCSI; Schroeder, Greg D. MD§; Vaccaro, Alexander R. MD, PhD, MBA§; Butler, Joseph S. PhD, FRCSI*,§

doi: 10.1097/BSD.0000000000000886
Narrative Review

Lower back pain is a commonly reported symptom during pregnancy. However, herniated lumbar disk disease is an uncommon cause for such pain. Cauda equina syndrome (CES) during pregnancy is a rare clinical scenario. This review highlights the epidemiology, diagnostic and treatment strategies, and challenges encountered when managing herniated lumbar disk disease and CES in pregnancy. Magnetic resonance imaging is the diagnostic modality of choice. Nonoperative treatment strategies are successful in the vast majority of cases in patients with a herniated disk in the absence of CES. CES and progressive neurological deficits remain absolute indications for surgical intervention regardless of gestational age. For such patients or those with debilitating symptoms refractory to nonoperative treatment strategies, surgery has been demonstrated to be safe in the pregnant patient population. However, surgery should be performed with obstetric and midwifery support should complications occur to the fetus.

*National Spinal Injuries Units, Department of Trauma & Orthopaedic Surgery, Mater Misericordiae University Hospital

Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin

Department of Trauma & Orthopaedic Surgery, Tallaght Hospital, Dublin, Ireland

§Rothman Institute, Thomas Jefferson University, Philadelphia, PA

Dr Schroeder has received funds to travel from AOSpine and Medtronic. Dr Vaccaro has consulted or has done independent contracting for DePuy, Medtronic, Stryker Spine, Globus, Stout Medical, Gerson Lehrman Group, Guidepoint Global, Medacorp, Innovative Surgical Design, Orthobullets, Ellipse, and Vertex. He has also served on the scientific advisory board/board of directors/committees for Flagship Surgical, AO Spine, Innovative Surgical Design, and Association of Collaborative Spine Research. Dr Vaccaro has received royalty payments from Medtronic, Stryker Spine, Globus, Aesculap, Thieme, Jaypee, Elsevier, and Taylor Francis/Hodder and Stoughton. He has stock/stock option ownership interests in Replication Medica, Globus, Paradigm Spine, Stout Medical, Progressive Spinal Technologies, Advanced Spinal Intellectual Properties, Spine Medica, Computational Biodynamics, Spinology, In Vivo, Flagship Surgical, Cytonics, Bonovo Orthopaedics, Electrocore, Gamma Spine, Location Based Intelligence, FlowPharma, R.S.I., Rothman Institute and Related Properties, Innovative Surgical Design, and Avaz Surgical. He has also served as deputy editor/editor of Spine. In addition, Dr Vaccaro has also provided expert testimony. The remaining authors declare no conflict of interest.

Reprints: Daniel P. Ahern, MBBCh, BAO, The National Spinal Injuries Unit, Department of Trauma & Orthopaedic Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland (e-mail:

Received April 7, 2018

Accepted July 2, 2019

Online date: September 6, 2019

© 2019 by Lippincott Williams & Wilkins, Inc.