Back pain and outcomes of pregnancy after instrumented spinal fusion for adolescent idiopathic scoliosis.

Back pain and outcomes of pregnancy after instrumented spinal fusion for adolescent idiopathic scoliosis.

World Neurosurg. 2019 Jan 02;:

Authors: Grabala P, Helenius I, Buchowski JM, Larson AN, Shah SA

Abstract
PURPOSE: We hypothesized that women undergoing scoliosis surgery who became pregnant would go to full-term, have uncomplicated pregnancies, and similar patient-reported outcome measures than non-pregnant patients and healthy controls.
METHODS: 205 females with AIS undergoing scoliosis surgery during 1998-2015 at several institutions in one country and 173 healthy women, without AIS, parous and nulliparous selected at random.
RESULTS: 108 women with AIS and no pregnancy (SNP), 97 with AIS and pregnancy (SP), 91 healthy controls and no pregnancy (HNP), and 82 healthy controls with pregnancy (HP) were reviewed. Mean follow-up was 5.0 years in the SNP, 6.0 years in the SP, 5.0 years in the HNP, and 5.0 years in the HP. The average time from surgery to childbirth was 5 years. Back pain (BP) during pregnancy was observed in 48% of the SP and 34% of the HP. BP after childbirth was present in 43% of the SP and 42% of the HP. Patients fused to L3 or L4 experienced more frequent low BP during pregnancy (40%) than those fused above L3, p<0.05). Cesarean section (CS) was performed for 64% and 33% in SP and HP, (p<0.05). As the lowest instrumented vertebra moved caudal to L4, the frequency of CS increased (p<0.05, R=0.8). The majority of CS in the SP were performed in patients fused to L4 (55%) vs. patients fused above and to L3 (45%), (p<0.05). The most common analgesia for CS was spinal (75% and 86% in SP and HP). Patients fused to L4 required general anesthesia significantly more often (7%) vs. those fused above L4 (4%, p<0.05). The health-related quality of life after spinal fusion showed general satisfaction and were similar for SNP and SP (mean 3.84 and 3.91, respectively). No sexual dysfunction was reported.
CONCLUSIONS: Women with a history of spinal fusion for AIS fused to L3 or L4 reported a higher incidence of low BP, and CS are more frequently required. This risk increased to 55% when spinal fusion to L4 was performed. The quality of life and sexual function were at same level in women after scoliosis surgery than in healthy controls.

PMID: 30610987 [PubMed - as supplied by publisher]

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