Pregnancy-associated Surgical Spine Disorders: A Systematic Review of Surgical Indications, Timing, Techniques, Maternal–Fetal Outcomes, and Proposal of a Multidisciplinary Management Algorithm

Pregnancy-associated spinal disorders that require surgical consideration remain uncommon, yet when they occur, they often place clinicians at the intersection of two competing priorities: preservation of maternal neurological function and protection of fetal well-being. Despite growing interest in this area, the available literature remains fragmented, largely confined to case reports, small case series, and condition-specific reviews, making it difficult to translate individual experiences into practical clinical guidance. This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses principles to synthesize current evidence regarding surgical indications, timing of intervention, operative strategies, perioperative considerations, and maternal–fetal outcomes in pregnant patients with spinal disorders. Electronic searches identified studies addressing degenerative, neoplastic, infectious, traumatic, vascular, and pregnancy-related spinal pathologies. Thirty-three studies met the predefined eligibility criteria and were included in the qualitative synthesis. Across the available evidence, lumbar disc herniation and cauda equina syndrome represented the most frequently reported surgical conditions, although clinically significant spinal tumors, vertebral hemangiomas, epidural abscesses, spinal hematomas, and traumatic instability were also encountered. A recurring observation emerged throughout the literature: pregnancy alone was rarely a reason to defer necessary spinal intervention. Rather, neurological deterioration, spinal instability, cord compression, infection, and progressive functional decline consistently drove treatment decisions. Magnetic resonance imaging remained the preferred diagnostic modality, while multidisciplinary collaboration among spine surgeons, obstetricians, anesthesiologists, radiologists, and maternal–fetal medicine specialists was central to successful outcomes. Although the overall evidence base remains limited and heterogeneous, the collective findings support individualized management guided by neurological severity, disease-specific risk, gestational age, and fetal viability. An integrated multidisciplinary management algorithm is proposed to facilitate evidence-informed decision-making and to identify priorities for future research in this challenging field.