五年随访记：腰椎滑脱的她能否怀孕做妈妈？请文末投票！

这是一个5年的随访，第一次找我看病，还是一个英国留学生的身份，虽然因为疫情，最后的学业(实习和毕业)是在国内完成的。

2022年10月9日，患者第一次来找我。

主诉：无明显诱因，腰部及髋周疼痛12天余。

现病史：自诉发现腰5峡部裂20月余，锻炼可缓解。可正常生活及工作，近期未进行锻炼，腰及髋周疼痛12天。不能久坐、久立，行走无影响。

查体：步入诊室，精神状态可，腰椎正常生理弯曲，各棘突旁无明显压痛、叩击痛、直腿抬高试验阴性，双下肢各关节活动可，末梢血运及感觉无明显异常。

辅助检查：

图1. 20210216腰椎正侧位X线片。

图2. 20210216腰椎过伸位X线片。

图3. 20210216腰椎过屈位X线片。

图4. 20210216腰椎右侧斜位X线片。

图5. 20210216腰椎左侧斜位X线片。

图6. 20210304腰椎MRI1。

图7. 20210304腰椎MRI中2。

图8. 20210304腰椎MRI左1。

图9. 20210304腰椎MRI左2。

患者携带的检查已1年余，建议重新复查影像资料。

图10. 20221009我的门诊病历。

图11. 20221009西京医院腰椎正侧位X线片。

图12. 20221009西京医院腰椎过伸过屈侧位X线片。

图13. 20221009西京医院腰椎双斜位X线片。

图14. 20221009西京医院腰椎6位X线片检查报告单。

图15. 20221009西京医院骨密度。

复查影像学资料变化不大，前滑脱似有加重，无症状，因此继续建议锻炼核心肌群训练，不做手术。

2023年2月15日，患者第二次做腰椎MRI检查，如下：

图16. 20230215西京医院腰椎MRI01。

图17. 20230215西京医院腰椎MRI02。

图18. 20230215西京医院腰椎MRI03。

图19. 20230215西京医院腰椎MRI04。

2026年3月30日，患者复诊，携带近期体检腰椎MRI检查结果就诊。

图20. 20260212西安交大二院桡骨远端骨密度。

图21. 20260213西安交大二院腰椎MRI01。

图22. 20260213西安交大二院腰椎MRI02。

图23. 20260213西安交大二院腰椎MRI检查报告。

2026年腰椎MRI显示的腰5滑脱与2023年腰椎MRI的滑脱变化不大，未再有加重，追问患者，平时核心肌群锻炼坚持的不好。平时也无症状，已工作和结婚。

工作与生活无影响。

建议其继续加强核心肌群训练，是否怀孕，或者如果想怀孕，是否需要手术，目前没有证据证明腰椎滑脱不能怀孕，也没有证据证明怀孕会加重腰椎滑脱，但从很朴素的理解来说，怀孕很有可能加重腰部疼痛表现。

图24. 20260330我的门诊病历。

然后我就查阅了一下文献，以spondylolisthesis and pregnancy查阅www.pubmed.gov，有44篇文献，绝大部分文献都很老旧，最早的文献是1953年，

CHAMP CJ. Spondylolisthesis and pregnancy; a case report. J Obstet Gynaecol Br Emp. 1953 Dec;60(6):913-4. doi: 10.1111/j.1471-0528.1953.tb07297.x.

看不到全文或者摘要。

TRELFORD JD. SPONDYLOLISTHESIS AND PREGNANCY. Am J Obstet Gynecol. 1965 Feb 1;91:320-5. doi: 10.1016/0002-9378(65)90245-0.

这个也看不到全文和摘要。

在44篇文献中，找到以下几篇相关文献。将英文摘要及翻译分享与大家，请大家建议，该患者为了怀孕，是否应该做手术，复位稳定融合腰5-骶1？

1. Skriabin EG, Brynza NS, Ivanova NV, Gaĭsin AG. [Complex treatment of vertebrogenic pain syndrome in women during pregnancy][Article in Russian]. Vopr Kurortol Fizioter Lech Fiz Kult. 2002 Mar-Apr:(2):29-31.

Abstract

The proposed system of non-pharmacological treatment has been tried in 325 pregnant women with pain syndrome associated with spinal lesions (osteochondrosis, scoliosis, malformations, sequela of compression vertebral fractures, spondylolisthesis). The treatment combined orthopedic aids, relaxing massage, muscular relaxation, mobilization of functional blocks of intervertebral joints and pelvic junctions, therapeutic exercises. The above non-pharmacological system relieved vertebral pain syndrome partially or completely in 82% of the treated pregnant women.

325例脊柱疾病（骨软骨病、脊柱侧弯、畸形、压缩性椎体骨折后遗症、腰椎滑脱）引起腰痛孕妇患者，非药物治疗（骨科康复、放松按摩、肌肉放松锻炼、骨盆及椎体活动单元动态训练）等可使82%的孕妇患者缓解症状。

2. Saraste H. Spondylolysis and pregnancy--a risk analysis. Acta Obstet Gynecol Scand. 1986;65(7):727-9. doi: 10.3109/00016348609161490.

Abstract

A possible interference of various musculo-skeletal anomalies with pregnancy is often discussed by obstetricians. Pregnancy as a risk factor for progression of spondylolisthesis, olisthesis as a risk factor for pregnancy complications, and pregnancy in women with spondylolysis as the cause of increased low-back symptoms, are questions hitherto not analysed. In the present study, a comparison between men, non-pregnant women, and women who had been pregnant, was made with respect to the degree of spondylolisthesis and its subsequent progression over an observation period of at least 20 years. Occurrence and intensity of low-back symptoms, and functional impairment due to low-back symptoms (such as change of work, sick-leave, sick-pension, limitation in non-occupational activities, and treatment) during this long observation time were also analysed. The mean values for the group of women who had been pregnant did not differ from those of the other groups as regards any of these variables. On the basis of these results, it is concluded that pregnancy does not constitute a risk for progression of spondylolisthesis, or for increased low-back symptoms in a woman with spondylolysis. Nor is spondylolysis, with or without olisthesis, a risk factor for pregnancy complications.

产科医生经常讨论各种肌肉骨骼异常对妊娠可能产生影响。妊娠作为腰椎滑脱进展的风险因素、滑脱作为妊娠并发症的风险因素，以及患有峡部裂的妇女妊娠导致腰痛症状加重，这些问题迄今为止尚未进行分析。本研究对患有腰椎峡部裂的男性、非妊娠妇女和已妊娠妇女随访至少20年，比较腰椎滑脱程度及进展情况。同时，研究随访期间腰痛症状的发生率和强度，以及由腰痛症状引起的功能损害（如工作变动、病假、病假津贴、非职业活动受限和治疗）。在所有这些变量中，已妊娠妇女组的平均值与其他组无差异。基于这些结果，可以得出结论：妊娠并不会增加腰椎滑脱的进展风险，也不会增加患有腰椎峡部裂妇女腰痛症状加重的风险。同样，无论是否伴有滑脱，腰椎峡部裂也不是妊娠并发症的风险因素。

3. Elliott JM, Fleming H, Tucker K. Asymptomatic spondylolisthesis and pregnancy. J Orthop Sports Phys Ther. 2010 May;40(5):324. doi: 10.2519/jospt.2010.0407. Case Reports

Abstract

The patient was a 32-year-old woman diagnosed with grade III spondylolisthesis at the age of 18. While the patient had not experienced back pain in recent years, she anticipated a recurrence of symptoms during her final trimester of pregnancy. Lumbar magnetic resonance imaging was used to confirm the presence of grade IV spondylolisthesis.

一位32岁女性患者，18岁时被诊断为III度腰椎滑脱。近年来无腰背部痛，但她担心在怀孕的最后三个月症状会复发。做腰椎MRI检查表明腰椎滑脱由III度进展为IV度。

4. Yoseph ET, Taiwo RT, Kiapour A, et al. Pregnancy-Related Spinal Biomechanics: A Review of Low Back Pain and Degenerative Spine Disease. Bioengineering (Basel). 2025 Aug 10;12(8):858. doi: 10.3390/bioengineering12080858. Review.

Abstract

Pregnancy induces substantial anatomical, hormonal, and biomechanical changes in the spine and pelvis to accommodate fetal growth and maintain postural adaptation. This narrative review synthesizes peer-reviewed evidence regarding pregnancy-related spinal biomechanics, with a particular focus on low back pain, spinopelvic alignment, sacroiliac joint dysfunction, and potential contributions to degenerative spinal conditions. A systematic search of PubMed, Embase, and Google Scholar was conducted using Boolean operators and relevant terms, yielding 1050 unique records, with 53 peer-reviewed articles ultimately cited. The review reveals that increased lumbar lordosis, ligamentous laxity, altered gait mechanics, and muscular deconditioning elevate mechanical load on the lumbar spine, predisposing up to 56% of pregnant individuals to low back pain. These changes are often associated with sacroiliac joint laxity, anterior pelvic tilt, and multiparity. Long-term risks may include degenerative disc disease and spondylolisthesis. Conservative interventions such as pelvic floor muscle training, prenatal exercise, and surface topography monitoring offer symptom relief and support early rehabilitation, although standardized protocols and longitudinal outcome data remain limited. Pregnancy-related spinal changes are multifactorial and clinically relevant; an interdisciplinary approach involving spinal biomechanics, physical therapy, and obstetric care is critical for optimizing maternal musculoskeletal health.

妊娠会导致脊柱和骨盆发生显著的解剖学、激素和生物力学变化，以适应胎儿的生长并维持姿势适应性。本综述综合了关于妊娠相关脊柱生物力学的同行评审证据，特别关注腰痛、脊柱骨盆力线、骶髂关节功能障碍以及这些变化对退行性脊柱疾病的潜在影响。通过使用布尔运算方法对PubMed、Embase和Google Scholar进行系统检索，共获得1050条独立记录，最终引用了53篇同行评审文章。综述显示，腰椎前凸增加、韧带松弛、步态力学改变以及肌肉功能减退会增加腰椎的机械负荷，使多达56%的孕妇易患腰痛。这些变化通常与骶髂关节松弛、骨盆前倾和多产有关。长期风险可能包括退行性椎间盘疾病和腰椎滑脱。盆底肌训练、产前运动和体表形态监测等保守干预措施可缓解症状并支持早期康复，尽管标准化方案和纵向结果数据仍然有限。妊娠相关的脊柱变化是多因素的，且具有临床相关性；采用脊柱生物力学、物理治疗和产科护理相结合的跨学科方法对于优化孕产妇肌肉骨骼健康至关重要。

欢迎您在评论区留下您的答案。

问题1:这个腰5峡部裂椎体滑脱的她,为了怀孕当妈妈,需要手术吗?3（单选）

A：手术

B：不手术

问题2:如果不手术,怀孕会导致腰5椎体滑脱加重吗?（单选）

A：加重

B：不加重