Scoliosis and Pregnancy

Scoliosis and PregnancySeveral young adult patients and parents of adolescents we treat have recently expressed their concerns about scoliosis and pregnancy. Whether you’ve had scoliosis surgery or not, if you’ve ever wondered about the effects of pregnancy on the scoliotic body, you are not alone.

Pregnancy with scoliosis is a topic we’ve rarely covered in print so we decided to do a bit of reporting for our readers. There really isn’t as much research on the topic as you would think considering that when it comes to scoliosis, women outnumber men about 8:1.

“Confounding conclusions” exist about the effect of pregnancy on scoliosis. Long story short: the conclusions are pretty inconclusive. Lebel et al. note that it is nearly impossible to counsel patients [1].

Almost anyone breathing can tell you that the physical changes experienced during pregnancy are significant. One physical effect that may be a concern for those with scoliosis is the hyper-elasticity of supportive connective tissues during pregnancy. This is what “ultimately allows the widening of the pelvic ring for the birth of a child [2].”

Schroeder et al. state that there have been cases when pregnancy may have been associated with acceleration in scoliosis curve progression. However, due to inconclusive evidence, these authors suggested that a cohort of non-operated women be prospectively followed in order to determine the effect (if any) of pregnancy on curve progression [2].

A review study by Asher et al. concluded that “curve progression in untreated scoliosis patients does not appear to be influenced by pregnancy [3].” This review cites a retrospective study by Betz et al. that compared 175 women with scoliosis who had been pregnant, to 180 women with scoliosis who had not. Of the first group, only four had problems associated with delivery and the rate of c-section was half the national average [4].

Another review stated that there was no correlation between the number of pregnancies and lumbar or major curve progression, or between curve progression and age at first pregnancy [5]. This review cites a study by Danielsson and Nachemson which reported that only minor problems occurred during pregnancy and delivery and that scoliosis did not increase as a result of pregnancy [6]. When it came to the age of first pregnancy among the surgically-treated vs. brace-treated the age of the subjects in the study did not differ significantly. Incidence of low back pain during pregnancy did not differ significantly either – 35% for the surgically treated, 43% for the brace treated, and 28% for the non-scoliosis control group. The rate of C-section during the first pregnancy was reported at 19% for the surgically treated, 14% for the brace treated and 18% for the control group. Those having surgery did experience a greater incidence of vacuum extractions (16%) compared with the control group (5%) or those treated by brace (8%) [6].

Similarly, in a study by Orvomaa et al., low back pain during pregnancy occurred in about 40% of patients having had Harrington Rod surgery. It was noted, however, that back pain was “severe enough to cause sick leave only in 11% of the pregnancies [7].” According to Orvomaa’s study, the rate of C-section was slightly higher in the group of operated scoliosis patients (23% versus 15% in the control group) [7]. Falick-Michaeli concluded that women who had “scoliosis correction surgery suffer from an increased incidence of long-term back pain after pregnancy [8].” They also suggested that a larger study on this topic seems warranted.

Some believe that having rods in the lumbar spine and fusion may reduce the chance of being able to have an epidural just prior to delivery. The decision to have an epidural after spinal fusion surgery is based on many factors, such as the condition of the fusion, the amount of scar tissue, personal preference, and the comfort level of the anesthesiologist performing the epidural. Some may choose not to perform an epidural due to the risk of infecting fusion hardware or missing the right spot. When the vertebrae are fused together, the epidural space can be more difficult to get into, however, it is not impossible [6].

There are several forums on the topic with comments from women who consulted with an experienced anesthesiologist willing to perform the epidural. Dr. Moramarco advises preparing ahead of time and bringing your most current pre-pregnancy x-rays with you to the delivery. He has had calls from the hospital to provide scoliosis x-rays for a patient in labor.

The Schroth method and pregnancy, to the best of our knowledge, has not been studied. However, experience and common sense dictate that strengthening and stabilizing the spine prior to pregnancy and knowing how to manage scoliosis can only help. As always, with scoliosis, circumstances vary by individual so consulting an expert is recommended.

1) Lebel DE, Sergienko R, Wiznitzer A, Velan GJ, and Sheiner E. Mode of delivery and other pregnancy outcomes of patients with documented scoliosis. The Journal of Maternal-Fetal & Neonatal Medicine. 2012;25(6):639-641.

2) Schroeder JE, Dettori JR, Ecker E, Kaplan L. Does pregnancy increase curve progression in women with scoliosis treated without surgery? Evidence-Based Spine-Care Journal. 2011;2(3):43-50.

3) Asher MA, Burton DC. Adolescent idiopathic scoliosis: natural history and long term treatment effects. Scoliosis. 2006;1:2.

4) Betz RR, Bunnell WP, Lamrecht-Mulier E, et al. Scoliosis and pregnancy. J Bone Joint Surg Am. 1987;69:90–96.

5) Bettany-Saltikov J, Weiss HR, Chockalingam N, Kandasamy G, Arnell T. A Comparison of Patient-Reported Outcome Measures Following Different Treatment Approaches for Adolescents with Severe Idiopathic Scoliosis: A Systematic Review. Asian Spine Journal. 2016;10(6):1170-1194.

6) Danielsson AJ, Nachemson AL. Childbearing, curve progression, and sexual function in women 22 years after treatment for adolescent idiopathic scoliosis: a case-control study. Spine (Phila Pa 1976) 2001;26:1449–1456.

7) Orvomaa E, Hiilesmaa V, Poussa M, et al. Pregnancy and delivery in patients operated by the Harrington method for idiopathic scoliosis. Eur Spine J 1997;6:304–7.

8) Falick-Michaeli T, Schroeder JE, Barzilay Y, Luria M, Itzchayek E, Kaplan L. Adolescent Idiopathic Scoliosis and Pregnancy: An Unsolved Paradigm. Global Spine Journal. 2015;5(3):179-184.