Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters

Abstract

BACKGROUND CONTEXT Lumbar disc herniation (LDH) is defined as a localized or focal displacement of disc material beyond the limitsof the intervertebral disc space. One in 10,000 pregnant women is reported to be affected by this condition. Despite there being established guidelines to manage LDH in the nonpregnant population, there is limited evidence to guide the optimal management in pregnancy. PURPOSE This study assessed the efficacy of different management options in managing LDH in pregnancy by critically appraising the available literature. STUDY DESIGN/SETTING Systematic review of the literature. PATIENT SAMPLE All pregnant patients presenting with lumbar disc hernation. METHODS Medline, Embase, PubMed, Science Direct and the Cochrane Library databases were searched from their inception to February 2017 using predetermined search terms. All peer-reviewed studies were included in this study. RESULTS Thirty case reports or case series involving 52 patients met inclusion criteria. Patients treated conservativelyhad a higher rate of full resolution of symptoms when compared to surgically treated patients (61.54% vs. 56.41%), and a lower rate of prolonged symptoms postmanagement (30.77% vs. 38.54%). Patients who were treated surgically for sciatica had a higher full recovery rate compared to patients being treated for cauda equina syndrome (80.95% vs. 27.78%) and reported a lower rate of persisting symptoms (14.29% vs. 66.67%). One hundred percent of patients managed conservatively had a successful birth with no maternal or fetal complications compared to 93.55% of surgically managed patients. CONCLUSIONS Pregnancy does not contraindicate the use of MRI, anaesthesia or surgical management. Careful assessmentof the risks and benefits for each patient need to be undertaken in conjunction with the obstetric team.