The impact of curve severity on obstetric complications and regional anesthesia utilization in pregnant patients with adolescent idiopathic scoliosis: a preliminary analysis

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Adolescent idiopathic scoliosis (AIS), the most common type of scoliosis, often presents immediately prior to a woman’s childbearing years; however, research investigating the impact of AIS on women’s health, particularly pregnancy delivery outcomes, is sparse, with existing literature reporting mixed findings. Similarly limited are studies examining the change in scoliotic curve during or after pregnancy. Therefore, this study aims to determine 1) the impact of scoliotic curvature on obstetric complications (preterm births, induction of labor, and urgent/emergency caesarean section delivery), 2) regional anesthetic decision making and success during delivery for these patients, and 3) the effect of pregnancy on curve progression.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Records of all pregnant patients diagnosed with AIS at the authors’ institution who delivered between January 2002 and September 2016 were retrospectively reviewed. Demographic information, pre- and postpartum radiographic Cobb angles, and clinical data for each pregnancy and delivery were recorded and analyzed. The Wilcoxon rank-sum test and the Wilcoxon signed-rank test were used for statistical analyses.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Fifty-nine patients (84 deliveries) were included; 14 patients had undergone prior posterior spinal fusion. The median age at AIS diagnosis was 15.2 years, and the median age at delivery was 21.8 years. Overall, the median major Cobb angle prior to the first pregnancy was 25° (IQR 15°–40°). Most births were by spontaneous vaginal delivery (n = 45; 54%); elective caesarean section was performed in 17 deliveries (20%). Obstetric complications included preterm birth (n = 18; 21.4%), induction of labor (n = 20; 23.8%), and urgent/emergency caesarean section (n = 12; 14.0%); none were associated with severity of scoliosis curve or prior spinal fusion. Attempts at spinal anesthesia were successful 99% of the time (70/71 deliveries), even among the patients who had undergone prior spinal fusion (n = 13). There were only 3 instances of provider refusal to administer spinal anesthesia. In the subset of 11 patients who underwent postpartum scoliosis radiography, there was no statistically significant change in curve magnitude either during or immediately after pregnancy.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>The results of this study suggest that there was no effect of the severity of scoliosis on delivery complications or regional anesthetic decision making in pregnant patients with AIS. Moreover, scoliosis was not observed to progress significantly during or immediately after pregnancy. Larger prospective studies are needed to further investigate these outcomes, the findings of which can guide the prenatal education and counseling of pregnant patients with AIS.</jats:p></jats:sec>

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

“…46 - 54 Only six studies were prospective (12%). 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.…”

“…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.…”

Pregnancy and delivery in patients with idiopathic scoliosis

“…Среди более поздних работ внимания заслуживают исследования, опубликованные в 2017 г. Chan et al [14], а также Dewan et al [15]. В первое исследование вошли данные о 51 пациентке со сколиозом меньших степеней, чем IV: средний угол деформации при операции -25°, медианный -31°.…”

The Effect of Adolescent Idiopathic Scoliosis on Natural Delivery and Epidural Use in Pregnant Females

“…[10][11][12][13][14][15][16] Similarly, IS has been associated with lower rates of perinatal neuraxial anesthesia use in some studies, 2,14,15,17 with other studies showing no significant influence of IS on regional anesthesia decision making or success of the epidural placement. 18,19 These prior studies were relatively small, with fewer than 300 subjects in total, except for one meta-analysis of these small studies. 20 Given the conflicting results, there is a need for investigation into the delivery experiences of females with scoliosis in a large, diverse population with data stratification based on physical characteristics and demographic factors.…”

“…Although some studies have suggested that females with a history of IS have higher rates of CSs,7–9 other studies have disputed these results 10–16. Similarly, IS has been associated with lower rates of perinatal neuraxial anesthesia use in some studies,2,14,15,17 with other studies showing no significant influence of IS on regional anesthesia decision making or success of the epidural placement 18,19. These prior studies were relatively small, with fewer than 300 subjects in total, except for one meta-analysis of these small studies 20.…”