Maternal–fetal Risk Stratification and Treatment Pathways for Lumbosacral Radicular Pain in Pregnancy: A Systematic Review of Lumbar Disc Herniation, Sciatica, Pelvic Girdle Pain Mimics, Surgical Timing, and Obstetric–neonatal Outcomes

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BSTRACT

Lumbosacral radicular pain in pregnancy poses an uncommon but important diagnostic problem because lumbar disc herniation and radiculopathy may be obscured by the far more frequent low back and pelvic girdle pain of pregnancy. This systematic review, reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020, examined diagnostic differentiation, treatment pathways, and maternal–fetal outcomes. PubMed/MEDLINE, PubMed Central, Embase, Scopus, Web of Science, and the Cochrane Library were searched, with supplementary searches of ClinicalTrials.gov and reference lists. Of 1000 records identified, 33 studies met predefined eligibility criteria and were included in qualitative synthesis; heterogeneity precluded meta-analysis. Across the evidence, pregnancy-associated lumbosacral pain represented an overlapping clinical spectrum rather than a single disorder. Neurological examination was central to recognizing radiculopathy, particularly when dermatomal pain, sensory change, reflex abnormality, motor weakness, or sphincter dysfunction was present. Most patients without progressive neurological compromise improved with conservative, rehabilitation-based management. Surgery was infrequently required but remained appropriate for progressive deficits, severe refractory radiculopathy, or cauda equina syndrome, with obstetric planning individualized rather than dictated by spinal pathology alone. Interpretation is limited by heterogeneous definitions, mixed study designs, small pregnancy-specific surgical samples, inconsistent neonatal reporting, English-language restriction, and the absence of prospective protocol registration. The contributors’ work in this field is presently preliminary and focuses on systematically collecting, organizing, and integrating available data to support a maternal–fetal risk-stratification framework. Better prospective, pregnancy-specific studies are needed before firm recommendations on prognostic factors, surgical timing, delivery, and neonatal safety can be made.