Acta Neurochirurgica

, Volume 160, Issue 7, pp 1361–1370 | Cite as

Lumbar disk herniation during pregnancy: a review on general management and timing of surgery

  • Hugo Ardaillon
  • Yosef Laviv
  • Jeffrey E. Arle
  • Ekkehard M. Kasper
Review Article - Spine


Study design

Narrative review with case illustration.


Provide an overview of existing management strategies to suggest a guideline for surgical management of lumbar disk herniation in pregnant women based on time of presentation.


We performed a narrative review on the topic using the PubMed database. A total of 63 relevant articles published after 1992 were identified, of which 17 fulfilled selection criteria.


A total of 22 published cases of spine surgery for disk herniation during pregnancy were found in 17 studies on the topic. Prone positioning was reported in the majority of cases during the first and early second trimester. C-sections were performed prior to spine surgery in the prone position for the majority of patients operated during the third trimester. The left lateral position with continued pregnancy was preferred during the latter half of the second trimester when delivery of the fetus cannot yet be performed but surgery is indicated.


Spine surgery during pregnancy is a rare scenario but can be performed safely when needed if providers adhere to general guidelines. Surgical approaches and overall management are influenced by the stage of pregnancy.


Lumbar disc herniation Pregnancy Discectomy Radiculopathy Low back pain Cauda equina syndrome 


Compliance with ethical standards


No funding was received for this research.

Conflict of Interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.


  1. 1.
    Abou-Shameh MA, Dosani D, Gopal S, McLaren AG (2006) Lumbar discectomy in pregnancy. Int J Gynaecol Obstet 92:167–169CrossRefPubMedGoogle Scholar
  2. 2.
    ACOG (2011) ACOG Committee Opinion No. 474: nonobstetric surgery during pregnancy. Obstet Gynecol 117:420–421CrossRefGoogle Scholar
  3. 3.
    Adogwa O, Elsamadicy A, Reiser E, Ziegler C, Freischlag K, Cheng J, Bagley CA (2016) Comparison of surgical outcomes after anterior cervical discectomy and fusion: does the intra-operative use of a microscope improve surgical outcomes. J Spine Surg 2:25–30CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Akino K, Akita S, Yakabe A, Mineda T, Hayashi T, Hirano A (2008) Human mesenchymal stem cells may be involved in keloid pathogenesis. Int J Dermatol 47:1112–1117CrossRefPubMedGoogle Scholar
  5. 5.
    Al-areibi A, Coveney L, Singh S, Katsiris S (2007) Case report: anesthetic management for sequential cesarean delivery and laminectomy. Can J Anaesth 54:471–474CrossRefPubMedGoogle Scholar
  6. 6.
    Antón Capitán B, Malillos Torán M (2015) Síndrome de cauda equina en paciente embarazada con hernia de disco masiva. Revista Española de Cirugía Ortopédica y TraumatologíaGoogle Scholar
  7. 7.
    Barash PG (2009) Clinical Anesthesia. Lippincott Williams & WilkinsGoogle Scholar
  8. 8.
    Bigos S, Bowyer O, Braen G, Brown K, Deyo R, Haldeman S, Hart JL, Johnson EW, Keller R, Kido D (1994) Acute lower back problems in adults. Rockville, MD: Agency for Health Care Policy and ResearchGoogle Scholar
  9. 9.
    Brent RL (1999) Utilization of developmental basic science principles in the evaluation of reproductive risks from pre- and postconception environmental radiation exposures. Teratology 59:182–204CrossRefPubMedGoogle Scholar
  10. 10.
    Brown MD, Brookfield KF (2004) Lumbar disc excision and cesarean delivery during the same anesthesia. A case report. J Bone Joint Surg Am 86-A:2030–2032CrossRefPubMedGoogle Scholar
  11. 11.
    Brown MD, Levi AD (2001) Surgery for lumbar disc herniation during pregnancy. Spine 26:440–443CrossRefPubMedGoogle Scholar
  12. 12.
    Bydon M, Macki M, Abt NB, Sciubba DM, Wolinsky JP, Witham TF, Gokaslan ZL, Bydon A (2015) Clinical and surgical outcomes after lumbar laminectomy: An analysis of 500 patients. Surg Neurol Int 6:S190–S193CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Chestnut DH (2012) Nonobstetric Surgery During Pregnancy. Yearb Anesthesiol Pain Manag 2012:335–336CrossRefGoogle Scholar
  14. 14.
    Cohen-Kerem R, Railton C, Oren D, Lishner M, Koren G (2005) Pregnancy outcome following non-obstetric surgical intervention. Am J Surg 190:467–473CrossRefPubMedGoogle Scholar
  15. 15.
    Coleman MT, Trianfo VA, Rund DA (1997) Nonobstetric emergencies in pregnancy: trauma and surgical conditions. Am J Obstet Gynecol 177:497–502CrossRefPubMedGoogle Scholar
  16. 16.
    Crowhurst JA (2002) Anaesthesia for non-obstetric surgery during pregnancy. Acta Anaesthesiol Belg 53:295–297PubMedGoogle Scholar
  17. 17.
    Dupont J, Pierre A, Froment P, Moreau C (2003) The insulin-like growth factor axis in cell cycle progression. Horm Metab Res 35:740–750CrossRefPubMedGoogle Scholar
  18. 18.
    Edwards DRV, Aldridge T, Baird DD, Funk MJ, Savitz DA, Hartmann KE (2012) Periconceptional over-the-counter nonsteroidal anti-inflammatory drug exposure and risk for spontaneous abortion. Obstet Gynecol 120:113–122CrossRefPubMedGoogle Scholar
  19. 19.
    Fager CA (1994) Observations on spontaneous recovery from intervertebral disc herniation. Surg Neurol 42:282–286CrossRefPubMedGoogle Scholar
  20. 20.
    Fahy UM, Oni M, Findlay D, Sell P (1998) Surgical management of herniated lumbar disc in pregnancy. J Obstet Gynaecol 18:544–545CrossRefPubMedGoogle Scholar
  21. 21.
    Flickinger JC (2011) A radiobiological analysis of multicenter data for postoperative keloid radiotherapy. Int J Radiat Oncol Biol Phys 79:1164–1170CrossRefPubMedGoogle Scholar
  22. 22.
    Garmel SH, Guzelian GA, D’Alton JG, D’Alton ME (1997) Lumbar disk disease in pregnancy. Obstet Gynecol 89:821–822CrossRefPubMedGoogle Scholar
  23. 23.
    Geftler A, Sasson A, Shelef I, Perry ZH, Atar D (2015) Cauda equina syndrome in a 36 week gravida patient. Isr Med Assoc J 17:522–523PubMedGoogle Scholar
  24. 24.
    Gupta P, Gurumurthy M, Gangineni K, Anarabasu A, Keay SD (2008) Acute presentation of cauda equina syndrome in the third trimester of pregnancy. Eur J Obstet Gynecol Reprod Biol 140:279–281CrossRefPubMedGoogle Scholar
  25. 25.
    Hakan T (2012) Lumbar disk herniation presented with cauda equina syndrome in a pregnant woman. J Neurosci Rural Pract 3:197–199CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Hall EJ (1991) Scientific view of low-level radiation risks. Radiographics 11:509–518CrossRefPubMedGoogle Scholar
  27. 27.
    Hamilton BE MJ, Osterman MJK, et al. (2015) Births: Final data for 2014. National Vital Statistics Reports Vol. 64, No. 12Google Scholar
  28. 28.
    Hayakawa K, Mizutani J, Suzuki N, Haas C, Kondo A, Otsuka S, Fukuoka M, Otsuka T (2016) Surgical management of the pregnant patient with lumbar disc herniation in the latter stage of the second trimester. SpineGoogle Scholar
  29. 29.
    Iyilikçi L, Erbayraktar S, Tural AN, Celik M, Sannav S (2004) Anesthetic management of lumbar discectomy in a pregnant patient. J Anesth 18:45–47CrossRefPubMedGoogle Scholar
  30. 30.
    Kathirgamanathan A, Jardine AD, Levy DM, Grevitt MP (2006) Lumbar disc surgery in the third trimester—with the fetus in utero. Int J Obstet Anesth 15:181–182CrossRefPubMedGoogle Scholar
  31. 31.
    Katz JD, Hook R, Barash PG (1977) Fetal heart rate monitoring in patients undergoing surgery. Surv Anesthesiol 21:286–287Google Scholar
  32. 32.
    Kim HS, Kim SW, Lee SM, Ho S (2007) Endoscopic discectomy for the cauda equina syndrome during third trimester of pregnancy. J Korean Neurosurg Soc 42:419CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    LaBan MM, Perrin JC, Latimer FR (1983) Pregnancy and the herniated lumbar disc. Arch Phys Med Rehabil 64:319–321PubMedGoogle Scholar
  34. 34.
    LaBan MM, Rapp NS, von Oeyen P, Meerschaert JR (1995) The lumbar herniated disk of pregnancy: a report of six cases identified by magnetic resonance imaging. Arch Phys Med Rehabil 76:476–479CrossRefPubMedGoogle Scholar
  35. 35.
    Lee JM, Han IH, Moon SH, Choi BK (2011) Surgery for recurrent lumbar disc herniation during pregnancy: a case report. Korean J Spine 8:304–306CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    MacLennan AH, Nicolson R, Green RC, Bath M (1986) Serum relaxin and pelvic pain of pregnancy. Lancet 2:243–245CrossRefPubMedGoogle Scholar
  37. 37.
    Martel CG, Volpi-Abadie J, Ural K (2015) Anesthetic management of the parturient for lumbar disc surgery in the prone position. Ochsner J 15:259–261PubMedPubMedCentralGoogle Scholar
  38. 38.
    Marulasiddappa V, Raghavendra B, Nethra H (2014) Anaesthetic management of a pregnant patient with intracranial space occupying lesion for craniotomy. Indian J Anaesth 58:739–741CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Matthews LJ, McConda DB, Lalli TAJ, Daffner SD (2015) Orthostetrics: management of orthopedic conditions in the pregnant patient. Orthopedics 38:e874–e880CrossRefPubMedGoogle Scholar
  40. 40.
    Moon JH, Kwak SS, Park G, Jung HY, Yoon BS, Park J, Ryu KS, Choi SC, Maeng I, Kim B, Jun EK, Kim S, Kim A, Oh S, Kim H, Kim KD, You S (2008) Isolation and characterization of multipotent human keloid-derived mesenchymal-like stem cells. Stem Cells Dev 17:713–724CrossRefPubMedGoogle Scholar
  41. 41.
    Nielsen GL (2001) Risk of adverse birth outcome and miscarriage in pregnant users of non-steroidal anti-inflammatory drugs: population based observational study and case–control study. BMJ 322:266–270CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Nielsen GL, Skriver MV, Pedersen L, Sørensen HT (2004) Danish group reanalyses miscarriage in NSAID users. BMJ 328:109CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Ninke T, Thoma-Jennerwein S, Blunk J, Annecke T (2015) Anesthesia and pain management during pregnancy. Anaesthesist 64:347–356CrossRefPubMedGoogle Scholar
  44. 44.
    Ochi H, Ohno R, Kubota M, Hanyu R, Sakai K, Sugawara Y, Mukasa F, Kaneko K (2014) Case report: The operation for the lumbar disk herniation just after cesarean delivery in the third trimester of pregnancy. Int J Surg Case Rep 5:1178–1182CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Orvieto R, Achiron A, Ben-Rafael Z, Gelernter I, Achiron R (1994) Low-back pain of pregnancy. Acta Obstet Gynecol Scand 73:209–214CrossRefPubMedGoogle Scholar
  46. 46.
    Park SH, Kim MJ, Kwon J, Park JP, Park MS, Lim JS, Kim JH, Kim KW (2007) Solitary fibrous tumor arising from stomach: CT findings. Yonsei Med J 48:1056–1060CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Ray JG, Vermeulen MJ, Bharatha A, Montanera WJ, Park AL (2016) Association between MRI exposure during pregnancy and fetal and childhood outcomes. JAMA 316:952–961CrossRefPubMedGoogle Scholar
  48. 48.
    Timothy J, Anthony R, Tyagi A, Porter D, van Hille PT (1999) A case of delayed diagnosis of the cauda equina syndrome in pregnancy. Aust N Z J Obstet Gynaecol 39:260–261CrossRefPubMedGoogle Scholar
  49. 49.
    Vougioukas VI, Kyroussis G, Gläsker S, Tatagiba M, Scheufler KM (2004) Neurosurgical interventions during pregnancy and the puerperium: clinical considerations and management. Acta Neurochir 146:1287–1291, discussion 1291–1282CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Wien 2017

Authors and Affiliations

  • Hugo Ardaillon
    • 1
  • Yosef Laviv
    • 2
  • Jeffrey E. Arle
    • 2
  • Ekkehard M. Kasper
    • 2
  1. 1.Lyon-Sud School of MedicineUniversity Claude-Bernard Lyon-1Pierre-BéniteFrance
  2. 2.Department of NeurosurgeryBeth Israel Deaconess Medical CenterBostonUSA

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