School of Allied Health, Murdoch University, Perth, Australia -
Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
Eur J Phys Rehabil Med. 2023 Aug;59(4):505-521. doi: 10.23736/S1973-9087.23.08086-3.
Adolescent idiopathic scoliosis is the most common spinal deformity encountered in adolescents and larger curves are more prevalent in girls. For females with scoliosis, women's health issues are of particular concern, especially pregnancy. The aim of this review was to summarise the best available evidence to determine the influence of pregnancy on scoliosis-related outcomes in women with scoliosis and whether scoliosis affects maternal-health outcomes, differentiating between patients who have been managed conservatively and/or surgically.
A search was conducted using CINAHL, Scopus, Cochrane Database, MEDLINE, and EMBASE from inception to May 2023 to identify relevant articles in any language. The scoping review followed the PRISMA-ScR guidelines. Studies were eligible if they included pregnant women (primiparous or multiparous) with a diagnosis of scoliosis of unknown aetiology. The results were summarized by outcomes, including pregnancy and scoliosis-related outcomes and type of management.
Our comprehensive search strategy identified 6872 articles, of which 50 articles were eligible for this review. Back pain appears to be more prevalent in this population during pregnancy and associated with the major curve and the decrease of lumbar lordosis. There have been reports of failed attempted spinal anaesthesia among patients with instrumented scoliosis correction and minor complications related to epidural anaesthesia at a higher rate compared to non-instrumented patients and healthy controls, however successful spinal analgesia can be achieved in patients with instrumented scoliosis correction. Overall, the caesarean section rate was similar in scoliosis patients compared to controls without scoliosis and to national averages. Curve progression occurs in some but not all patients during pregnancy, and this phenomenon occurs irrespective of the treatment received.
Higher-quality prospective longitudinal research is needed to understand the relationship between pregnancy and adolescent idiopathic scoliosis. Further, the patient's perspective, concerns and fears surrounding pregnancy with scoliosis are yet to be explored. Exploring the impact of pregnancy on women with adolescent idiopathic scoliosis would have clinically relevant outcomes and could help provide pertinent answers to patients and healthcare workers and help guide future research.
青少年特发性脊柱侧凸是青少年中最常见的脊柱畸形，较大的脊柱侧凸在女孩中更为常见。对于患有脊柱侧凸的女性，女性健康问题尤其值得关注，尤其是怀孕问题。本综述的目的是总结现有最佳证据，以确定妊娠对患有脊柱侧凸女性脊柱侧凸相关结局的影响，以及脊柱侧凸是否会影响产妇健康结局，并区分接受保守和/或手术治疗的患者。
从开始到 2023 年 5 月，使用 CINAHL、Scopus、Cochrane 数据库、MEDLINE 和 EMBASE 以任何语言进行了检索，以确定相关文章。该范围综述遵循 PRISMA-ScR 指南。如果研究包括患有病因不明的脊柱侧凸的孕妇（初产妇或经产妇），则符合纳入标准。结果根据妊娠和脊柱侧凸相关结局以及管理类型进行总结。
我们全面的搜索策略确定了 6872 篇文章，其中 50 篇文章符合本综述的纳入标准。在这一人群中，怀孕期间似乎更普遍出现背痛，且与主要脊柱侧凸和腰椎前凸减少有关。有报道称，在接受器械矫正脊柱侧凸的患者中，尝试脊髓麻醉失败，且与非器械矫正患者和健康对照组相比，硬膜外麻醉相关的轻微并发症发生率更高，然而在接受器械矫正脊柱侧凸的患者中可以成功实现脊髓镇痛。总体而言，脊柱侧凸患者的剖宫产率与无脊柱侧凸的对照组和全国平均水平相似。在怀孕期间，一些但不是所有患者的脊柱侧凸都会进展，而且这种现象与所接受的治疗无关。
需要进行更高质量的前瞻性纵向研究，以了解妊娠与青少年特发性脊柱侧凸之间的关系。此外，患者对脊柱侧凸相关妊娠的看法、担忧和恐惧仍有待探讨。探讨妊娠对青少年特发性脊柱侧凸女性的影响将具有临床相关的结局，并有助于为患者和医护人员提供相关答案，帮助指导未来的研究。
