■怀孕期间背痛很常见,但是怀孕期间腰椎间盘突出症引起的疼痛很少见。本系统综述旨在全面分析妊娠期腰椎间盘突出症的文献。关注风险因素,发病率,临床表现,和管理。
■我们使用PubMed和WebofScience数据库进行了文献综述,包括1950年1月1日至2023年8月1日的研究。用于队列研究的关键评估技能计划(CASP)清单和用于病例对照研究的JoannaBriggs研究所关键评估清单用于评估偏倚风险。审查方案以前没有公布。
■共审查了41项研究,其中6个涉及发病率和危险因素,35个侧重于临床表现和管理。怀孕期间有症状的腰椎间盘突出症并不常见,根据磁共振成像(MRI)发现,在怀孕期间没有发现明显的易感性。然而,MRI检测出疝的患者更有可能报告背痛.非手术治疗导致更高的症状完全缓解率(69%vs.50%)和较低的剖宫产率(57%vs.70%)与手术管理相比。在接受手术治疗的患者中,与椎板切除术(17%)或联合入路(33%)相比,显微椎间盘切除术显示出更高的症状缓解率(59%).
虽然怀孕本身不会增加腰椎间盘突出症的风险,在怀孕期间,椎间盘脱垂的存在会导致背部疼痛。有质量差的证据,应谨慎解释。非手术管理,在没有包括肠和膀胱功能障碍在内的红旗症状的情况下,可以进行试验,并获得相对更好的症状缓解。此外,在本研究范围内,必要的手术治疗与妊娠并发症没有明确联系。
UNASSIGNED: Back pain in pregnancy is common, but pain from lumbar
disk herniations in pregnancy is rare. This systematic review aims to comprehensively analyse literature on lumbar
disk herniation in pregnancy, focusing on risk factors, incidence, clinical presentation, and management.
UNASSIGNED: We conducted a literature review using PubMed and Web of Science databases, including studies from January 1, 1950, to August 1, 2023. The Critical Appraisal Skills Programme (CASP) checklist for cohort studies and the Joanna Briggs Institute Critical Appraisal Checklist for case-control studies were utilised to assess risk of bias. The review protocol was not previously published.
UNASSIGNED: A total of 41 studies were reviewed, with 6 addressing incidence and risk factors and 35 focusing on clinical presentation and management. Symptomatic lumbar
disk herniation during pregnancy was found to be uncommon, with no significant predisposition noted during pregnancy as per magnetic resonance imaging (MRI) findings. However, patients with MRI-detected herniations were more likely to report back pain. Non-surgical management resulted in higher rates of complete symptom resolution (69% vs. 50%) and lower rates of cesarean section (57% vs. 70%) compared to surgical management. Among surgically treated patients, microdiscectomy showed higher symptom resolution (59%) compared to laminectomy (17%) or a combined approach (33%).
UNASSIGNED: While pregnancy does not inherently increase the risk of herniated lumbar disks, the presence of a prolapsed
disk can predispose to back pain during pregnancy. There is poor quality evidence that should be interpreted cautiously. Non-surgical management, in the absence of red-flag symptoms including bowel and bladder dysfunction may be trialled and yield comparatively better symptom resolution. Additionally, surgical management if necessitated has no clear link to pregnancy complications within the scope of this study.