Pregnancy and delivery in patients with idiopathic scoliosis

Abstract

Objective. To analyze the course of pregnancy and delivery that occurred before and after surgical correction of idiopathic scoliosis with instrumented fixation of the spine.Material and Methods. The paper presents a retrospective randomized study of 100 patients of reproductive age (18–35 years) with Lenke type 2–6 idiopathic scoliosis. The following aspects of pregnancy were analyzed: the possibility of independent conception, the pain severity according to VAS during each of the three trimesters of pregnancy, and the mode of delivery (naturally or by C-section). A comparative analysis of the data of patients operated on for the spine deformity correction before and after pregnancy and delivery was carried out. Data was collected using a questionnaire survey of patients. Detection and analysis of differences between groups were carried out using the χ 2 criterion.Results. A statistical relationship was found between the presence of instrumentation installed before delivery (during or before pregnancy) and the need for C-section. It was revealed that the lower the caudal end of instrumentation within the L3–S1 region, the higher the C-section occurrence. Predominantly thoracic scoliosis (Lenke types 2–4) is characterized by higher likelihood of independent conception and lower lumbar pain intensity during pregnancy than predominantly lumbar scoliosis (Lenke types 5–6). There are also certain difficulties in conducting spinal anesthesia in patients with installed instrumentation, which negatively affects the possibility of its use.Conclusion. The issue of the course of pregnancy and delivery in idiopathic scoliosis continues to be very significant for both patients and spine surgeons who supervise them. The solution to this issue is impossible without cooperation with obstetrician gynecologists and anesthetists planning and administering anesthetic management during delivery (which is especially important in case of impossibility or significant restriction of spinal anesthesia use in such patients).

The impact of pregnancy on women with adolescent idiopathic scoliosis: a scoping review

“…, managed conservatively (brace) or surgically). 11 , 12 , 17 , 25 , 35 , 38 , 43 , 44 , 58 In conservatively managed patients, Aulisa et al 15 reported no significant differences in the number of pregnancies in braced participants regardless of the size of the curve which was also reported by Cochrane and Nachemson 21 who found a pregnancy rate similar to the country’s national norm (Sweden). Conversely, compared to a healthy population, Misterska et al 32 reported a significant difference regarding the rate of pregnancy and the mean number of children.…”

“… 10 , 55 - 59 Most were North American (40%) 6 , 10 , 12 , 16 , 17 , 19 , 22 , 23 , 25 , 26 , 35 , 38 , 41 , 42 , 45 , 46 , 49 , 52 , 55 , 57 or European (44%) studies. 11 , 14 , 15 , 20 , 21 , 24 , 28 - 34 , 37 , 44 , 47 , 50 , 51 , 53 , 56 , 58 , 59 The study population of all included publications was recruited from hospitals or medical centres, except for two studies, where participants were recruited from the Gothenburg Scoliosis Database. 20 , 21 …”

“…While more than half of the studies were published prior to 2010 (N.=30), 10 - 12 , 14 , 16 , 17 , 20 - 23 , 25 , 28 , 31 , 33 , 34 , 36 - 38 , 45 - 49 , 51 - 54 , 56 - 58 some were published in the last decade (2011-2023) (N.=20) 6 , 15 , 18 , 19 , 24 , 26 , 27 , 29 , 30 , 32 , 35 , 39 , 41 - 44 , 50 , 55 , 59 , 60 including 14 published post-2015. 6 , 15 , 18 , 19 , 26 , 27 , 32 , 35 , 39 , 41 - 44 , 59 The mean age of participants was difficult to estimate as some studies provided the mean age of the entire population, which included both male and female participants. In contrast, others reported the mean age at the end of the scoliosis treatment, whether conservative or surgical.…”

“…Most studies looked at pregnancy in surgical cases (N.=34), 6 , 11 , 17 - 20 , 22 - 27 , 29 , 33 - 39 , 41 - 44 , 46 , 48 , 49 , 51 - 56 , 58 , 60 while fewer looked at pregnancy in conservatively managed patients (N.=17). 11 , 12 , 14 - 17 , 19 , 21 , 28 , 29 , 31 , 32 , 35 , 41 , 43 , 44 , 57 The characteristics of all included studies are reported in Supplementary Digital Material 2 (Supplementary Table I). 6 , 10 - 12 , 14 - 39 , 41 - 60 …”

“…Twenty-seven studies examined pregnancy-related outcomes explicitly looking at the success and number of pregnancies. 10 - 12 , 15 , 17 , 18 , 20 , 21 , 24 , 25 , 27 - 30 , 32 , 33 , 35 , 36 , 38 , 39 , 42 - 44 , 55 , 56 , 58 , 60 From these studies, seven reported outcomes in the conservatively managed patients, 10 , 15 , 21 , 28 , 29 , 32 , 43 11 in surgically managed patients, 18 , 20 , 24 , 27 , 33 , 36 , 39 , 42 , 55 , 56 , 60 and nine in mixed patient groups ( i.e. , managed conservatively (brace) or surgically).…”