No increase in pregnancy-related back pain, complication or sexual dysfunction following scoliosis surgery in adolescence

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pregnancySurgery for female adolescent idiopathic scoliosis patients appears to have no impact on complication rates for future pregnancy, according to data presented at the 51st Annual Meeting of the Scoliosis Research Society (SRS; 21–24 September, Prague, Czech Republic).

While those patients who underwent surgery in adolescence may require Caesarean section delivery twice as frequently as their normal counterparts, they report similar rates of back pain during pregnancy, and surgery does not seem to affect sexual satisfaction or quality of life.

Pawel Grabala, Regional Specialized Children’s Hospital, Olsztyn, Poland, told the SRS audience that, although patients and their families often have questions regarding the impact of scoliosis surgery on their ability to become pregnant, carrying the baby to full term, delivery and back pain, “we are not equipped to answer these questions due to insufficient evidence”.

The research team recruited 281 women from four centres. One cohort was comprised of women aged 16–45 years who had undergone surgery for scoliosis in adolescence and had subsequently become pregnant (SPG, n=37). This cohort was compared against three others: women who had undergone scoliosis surgery but had not become pregnant (SNG, n=168), a group of nulligravida women (n=41), and a group of primigravida women (n=35). The patients all answered questions on pregnancy, back pain during pregnancy, childbirth and perinatal complications. Results from SRS-22r and Female Sexual Function Index (FSFI) queries were also collected.

The average age at the time of scoliosis surgery was 16 years, and the mean time of childbirth after surgery was six years (range 2–13 years). Back pain during pregnancy was reported by 48% of the SPG group, compared with 34% of those in the primigravida group (p=0.22). In the SPG group, 5% of women reported complications, of which the most common was early childbirth. Caesarean section delivery was required in 62% of SPG patients; notably higher than the 31% of primigravida women. SRS-22r outcomes were comparable for the SPG and SNG cohorts at 3.84 and 3.91, respectively (p>0.5), while no patients reported sexual dysfunction as judged by the FSFI scale. Mean scores for sexual satisfaction were 5.55 for the SPG group, 4.02 for the SNG, 4.14 for the nulligravida group and 4.02 for the primigravida group.

Grabala told the audience that in the future, researchers should examine why the rate of Caesarean section delivery is so much higher for patients who have undergone spinal fusion in the treatment of adolescent idiopathic scoliosis. He also suggested that the success of epidural anaesthesia in women who have undergone posterior spinal fusion could be analysed, as could the incidence of preterm labour or delivery, and prolonged labour in scoliosis surgery patients.

Following the presentation, an audience member referred back to previous research which had shown similar outcomes (with the exception of Caesarean section delivery rate). This study found one in six of those patients who had undergone surgery and not subsequently become pregnant, did so because of fears that their child would have scoliosis or back pain (these patients were treated when adolescent idiopathic scoliosis was still considered a life-threatening condition). She suggested that the present study was limited by its failure to record why certain women who had undergone treatment for scoliosis had not become pregnant. Many women in her own research, she argued, had consciously decided not to have children because of safety fears for both themselves and their potential offspring.

Grabala agreed that this line of questioning may encourage further interesting debate, and was an important consideration to take into account when studying the safety of pregnancy childbirth in this patient population.

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