Pregnancy and childbirth after adolescent idiopathic scoliosis surgery: A study of 80 pregnancies

Background

Adolescent idiopathic scoliosis (AIS) is a common spinal disease affecting 2% of adolescents, and women in 90% of the cases. When a surgical treatment is opted for, many questions are frequently asked by families and patients about the course of pregnancy and childbirth after the spinal fusion. This subject remains little studied in the literature, especially with modern instrumentation techniques.

Hypothesis

The goal was to describe pregnancy and childbirth after AIS surgery in terms of access to epidural analgesia, need for cesarean section (c-section), and low back pain during and after pregnancy. We thus hypothesized that women undergoing spinal surgery for AIS have subsequently uncomplicated pregnancies and childbirths, and have access to epidural analgesia as women without AIS do.

Patients and methods

In this retrospective multicenter study, 198 women who underwent surgery between 1984 and 2014 were reviewed from two university hospitals. Among them, 50 women became pregnant, for a total of 80 pregnancies. Surgical data were collected [approach, uppermost and lowermost instrumented vertebra (UIV, LIV)]. Pregnancy characteristics were evaluated: time between surgery and pregnancy, number of births, mode of analgesia, type of delivery, weight gain. Occurrence of low back pain during pregnancy and at follow-up was recorded using ODI.

Results

Of the 50 women, 34 had posterior surgery and 16 had anterior surgery. Deliveries took place from 1988 to 2018. Of the 80 pregnancies, 81% were delivered by vaginal route (n = 65/80), and an effective epidural anesthesia was performed for 49% of them (n = 39/80). Epidural analgesia failed in 9% of pregnancies (n = 7/80), and was denied in 35% of cases (n = 28/80), half of the time by anesthesiologists (n = 15/80). Patients refused epidural in 13 pregnancies (16%, n = 13/80). A general anesthesia was used in six pregnancies (8%, n = 6/80), for c-sections only. Back pain was reported in 48% of the pregnancies (n = 38/80). The level of fusion was correlated with c-section, and conversely with epidural anesthesia.

Discussion

A normal pregnancy with vaginal delivery seems to be the rule for women undergoing spinal fusion for AIS. The c-section rate in AIS women was similar to the general population (19%). Yet, access to epidural anesthesia still seems problematic with only 49% of births in this series, compared with 81% in the French population.

Level of evidence

IV, retrospective cohort.