Dealing with Radiculopathy when You Are Pregnant

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Radiculopathy is a set of conditions resulting from irritation or injury. This causes pressure on the nerve root of a spinal nerve, the root being located near where the nerve exits the spine and its individual nerve cells (called neurons or fibers) synapse (connect) with neurons of the spinal cord. Commonly called a “pinched nerve”, the condition usually results from what doctors call a herniated (prolapsed) nucleus pulposus. This term means that the gelatinous central part of a disk between two vertebrae (an intervertebral disc) slips out of place (a “slipped disc”). Other reasons for the problem include arthritis, bone spurs, and scar tissue from surgery. These issues cause the opening through which the spinal nerve exits to become narrow. Doctors call this narrowing foraminal stenosis. Other situations leading to radiculopathy include diabetes and injuries to the nerve root itself. Radiculopathy is classified into cervical radiculopathy (occurring in the neck), thoracic radiculopathy (occurring in the upper back), and lumbar radiculopathy (occurring in the lower back. Of these types of radiculopathy, lumbar (also called lumbo-sacral) and cervical are the most common. If you have lumbar radiculopathy, pregnancy can exacerbate it. The reason is that the growing womb puts excess pressure on the lower back.

Lower back troubles, due to multiple causes, has been reported with a varying amount of prevalence during pregnancy. What is clear, however, is that the number of cases increases during the third trimester, because of the physical stress of the growing womb. Herniated intervertebral disc, the most common type of radiculopathy in women of reproductive age, affects 1 in 10,000 pregnant women.

Most radiculopathy in pregnancy is lumbar radiculopathy. This condition causes sciatica, which is pain radiating from the buttock, down your leg, sometimes all the way to the foot, with episodes tingling and numbness and sometimes burning. You may also suffer aches and pains in the lower back. Pregnancy has the potential to exacerbate your symptoms, so to the extra stress that it places on your lower back. You also may have some trouble standing or walking. Depending on the location of the injury there also is a possibility of urinary or bowel incontinence. Maternal radiculopathy does not have any direct effects on the fetus.

Doctors can diagnose your radiculopathy with magnetic Resonance Imaging (MRI) showing the disc out of place and pushing in a nerve root. MRI is safe for your fetus, but some people find it unpleasant, because you need lie inside the MRI machine for an extended time. In addition to MRI, you also may be evaluated with a nerve conduction velocity study and another test called electromyography.

Radiculopathy can be treated with acetaminophen for pain. Normally, patients also take non-steroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation, but NSAIDs must be avoided during the third trimester, because they can cause problems for the fetus. Notably, NSAIDs can cause premature closure of the ductus arteriosus, a blood vessel that allows blood to move from the pulmonary artery into the aorta (the large artery that carries blood from the heart’s left ventricle) during fetal life. To counter muscle spasms, you may be given muscle relaxant medications, such as cyclobenzaprine, which is thought to be fairly safe in pregnancy. More severe cases can be treated with corticosteroids injected into a region outside the spinal cord called epidural space at the appropriate spinal level. Opioid medications can be given for severe pain. They carry risks for the fetus, but can be given very carefully in women who really need them. You and your doctor should discuss the risks and benefits of each medication and options for stopping or replacing certain medications, such as opioids.

Nursing women can take the drug cyclobenzaprine against muscle spasms, but the baby should be monitored for drowsiness and signs of developmental problems. NSAIDs are considered to be fairly safe in mothers who are nursing.

Physical therapy is an important component in managing radiculopathy. Occupational therapy is also useful; this therapy helps you learn how to function better with the condition. In some cases, medication and physical therapy will not be enough and you will need surgical treatment, which could include removal of the prolapsed part of the disc, fusion of two or more vertebrae with removal of the entire disc between them, implantation of an artificial disc, or, in cases of spinal stenosis, decompressive laminectomy. In the latter procedure, thickened bone and other tissue that is narrowing the spinal canal is removed.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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