disc herniation and future pregnancy?

[ctts]

In the past 10 days, I have seen two young female patients with history of disc herniation and lumbar radiculopathy, who wanted advice on whether it would be safe for them to go through a pregnancy. One of my patients already had a microdiscectomy. The other patient was advised by a spine surgeon that she should not get pregnant.

I would advise my patients that there is a risk of worsening disc herniation, but that pregnancy is not absolutely contraindicated. I would also suggest they get the opinion of an OB and spine surgeon. But if everyone has different opinions, then I don't know how they would take it. I may be mistaken, but in the end, I would guess that if having a child is a high priority in their life, most patients in that situation will take their chances with pregnancy.

What are your thoughts? How would you advise your patients?

Here is an abstract I found:

Acta Neurochir (Wien). 2012 Feb;154(2):329-34. Epub 2011 Oct 26.
Pregnancy and childbirth after microsurgery for lumbar disc herniation.
Berkmann S, Fandino J.
Source
Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, 5001 Aarau, Switzerland. [email protected]
Abstract
BACKGROUND:
The influence of previous lumbar discectomy on pregnancy and childbirth has not been extensively studied. This study reports the course of pregnancies after lumbar discectomy.
METHOD:
Twenty-six 31.5 ± 3.6-year-old patients who had delivered 39 children were included. All patients underwent lumbar microsurgical discectomy prior to childbirth. Demographic and surgical data were collected from hospital records and patient questionnaires. The presence and course of low back pain (LBP) and radiculopathy signs were noted.
FINDINGS:
Mean latency between surgery and childbirth was 42.5 ± 34.8 months. Delivery was at gestational week 36 to 42, and the average weight of the newborn was 3,390 ± 0.490 g. Prevalence and new onset of symptoms during pregnancy was as follows: low back pain, 76% and 60%; leg pain 37% and 18%; motor deficits 13% and 6%; and sensory deficits 39% and 19%, respectively. No recurrent lumbar disc herniation was diagnosed within 6 months after pregnancy. Patients suffering from radicular pain during pregnancy were at risk of persistence of symptoms 6 months after delivery. Three patients had had surgery because of recurrent lumbar disc herniation during the follow-up of 7.73 ± 2.66 years.
CONCLUSIONS:
The incidence of radicular pain during pregnancy after microsurgical discectomy for lumbar disc herniation was 18%. The incidence and prevalence of LBP are among the highest reported in the literature. The incidence of low back pain and radiculopathy signs does not change significantly with subsequent pregnancies. The operation rate for recurrent lumbar disc herniation or adjacent level disease after pregnancy seems not to be higher than the overall rate reported in the literature.
PMID: 22037981 [PubMed - indexed for MEDLINE]

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[ctts]

Forgot to share also that just today, a PCP who refers patients to me called asking for advice for his wife who just gave birth and has radicular symptoms! Interestingly, she had similar symptoms with a prior pregnancy, but MRI at the time apparently did not show any significant disc herniation. All this, along with the two female patients that I mentioned, in a span of 10 days, whereas I have never been directly confronted with this question after all this time seeing patients.

 

[mille125]

In the past 10 days, I have seen two young female patients with history of disc herniation and lumbar radiculopathy, who wanted advice on whether it would be safe for them to go through a pregnancy. One of my patients already had a microdiscectomy. The other patient was advised by a spine surgeon that she should not get pregnant.

I would advise my patients that there is a risk of worsening disc herniation, but that pregnancy is not absolutely contraindicated. I would also suggest they get the opinion of an OB and spine surgeon. But if everyone has different opinions, then I don't know how they would take it. I may be mistaken, but in the end, I would guess that if having a child is a high priority in their life, most patients in that situation will take their chances with pregnancy.

What are your thoughts? How would you advise your patients?

Here is an abstract I found:

Acta Neurochir (Wien). 2012 Feb;154(2):329-34. Epub 2011 Oct 26.
Pregnancy and childbirth after microsurgery for lumbar disc herniation.
Berkmann S, Fandino J.
Source
Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, 5001 Aarau, Switzerland. [email protected]
Abstract
BACKGROUND:
The influence of previous lumbar discectomy on pregnancy and childbirth has not been extensively studied. This study reports the course of pregnancies after lumbar discectomy.
METHOD:
Twenty-six 31.5 ± 3.6-year-old patients who had delivered 39 children were included. All patients underwent lumbar microsurgical discectomy prior to childbirth. Demographic and surgical data were collected from hospital records and patient questionnaires. The presence and course of low back pain (LBP) and radiculopathy signs were noted.
FINDINGS:
Mean latency between surgery and childbirth was 42.5 ± 34.8 months. Delivery was at gestational week 36 to 42, and the average weight of the newborn was 3,390 ± 0.490 g. Prevalence and new onset of symptoms during pregnancy was as follows: low back pain, 76% and 60%; leg pain 37% and 18%; motor deficits 13% and 6%; and sensory deficits 39% and 19%, respectively. No recurrent lumbar disc herniation was diagnosed within 6 months after pregnancy. Patients suffering from radicular pain during pregnancy were at risk of persistence of symptoms 6 months after delivery. Three patients had had surgery because of recurrent lumbar disc herniation during the follow-up of 7.73 ± 2.66 years.
CONCLUSIONS:
The incidence of radicular pain during pregnancy after microsurgical discectomy for lumbar disc herniation was 18%. The incidence and prevalence of LBP are among the highest reported in the literature. The incidence of low back pain and radiculopathy signs does not change significantly with subsequent pregnancies. The operation rate for recurrent lumbar disc herniation or adjacent level disease after pregnancy seems not to be higher than the overall rate reported in the literature.
PMID: 22037981 [PubMed - indexed for MEDLINE]

Pregnancy is not a contraindication. Some patients have not change. Some feel better (likely progesterone effect). Some feel worse (obvious reasons here). Like most things in medicine it needs to be taken on a case by case based. Of note both TENS and lidoderm are safe to give in pregnancy. I wouldnt TENS the abdomen though.

 

[PinchandBurn]

Pregnancy is not a contraindication. Some patients have not change. Some feel better (likely progesterone effect). Some feel worse (obvious reasons here). Like most things in medicine it needs to be taken on a case by case based. Of note both TENS and lidoderm are safe to give in pregnancy. I wouldnt TENS the abdomen though.

TENS? really ? I think i would do hte lidoderm thing first.

Also, you could tell them that you could do a ESI if the radiculopathy is really bad during pregnancy (w/o fluro of course).

 

[Sven Berkmann]

Thank you for citing our work! Personally and based on our experience, I would never advise a patient who is doing well to not become pregnant after lumbar discectomy. It's obvious that it's another story for patients who have radicular pain before becoming pregnant. To those I would suggest to fix the problem before pregnancy limits the use of analgetics. In this retrospective study a lot of patients who suffered from radicular pain during pregnancy also experienced a significant relief after delivery. Differences in sagittal balance and tissue swelling induced by hormonal changes may be possible explanations for this phenomenon as none of the patients suffered from a recurrent lumbar disc hernia.