Department of Orthopedic Surgery, Hôpital européen Georges Pompidou (HEGP), Paris University, Paris, France.
Department of Orthopedic Surgery, Hôpital de la Pitié Salpêtrière, Paris University, Paris, France; Department of Orthopedic Surgery, Hôpital Necker-Enfants malades, Paris University, Paris, France.
Orthop Traumatol Surg Res. 2024 Nov;110(7):103711. doi: 10.1016/j.otsr.2023.103711. Epub 2023 Oct 18.
Adolescent idiopathic scoliosis (AIS) is a common spinal disease affecting 2% of adolescents, and women in 90% of the cases. When a surgical treatment is opted for, many questions are frequently asked by families and patients about the course of pregnancy and childbirth after the spinal fusion. This subject remains little studied in the literature, especially with modern instrumentation techniques.
The goal was to describe pregnancy and childbirth after AIS surgery in terms of access to epidural analgesia, need for cesarean section (c-section), and low back pain during and after pregnancy. We thus hypothesized that women undergoing spinal surgery for AIS have subsequently uncomplicated pregnancies and childbirths, and have access to epidural analgesia as women without AIS do.
In this retrospective multicenter study, 198 women who underwent surgery between 1984 and 2014 were reviewed from two university hospitals. Among them, 50 women became pregnant, for a total of 80 pregnancies. Surgical data were collected [approach, uppermost and lowermost instrumented vertebra (UIV, LIV)]. Pregnancy characteristics were evaluated: time between surgery and pregnancy, number of births, mode of analgesia, type of delivery, weight gain. Occurrence of low back pain during pregnancy and at follow-up was recorded using ODI.
Of the 50 women, 34 had posterior surgery and 16 had anterior surgery. Deliveries took place from 1988 to 2018. Of the 80 pregnancies, 81% were delivered by vaginal route (n=65/80), and an effective epidural anesthesia was performed for 49% of them (n=39/80). Epidural analgesia failed in 9% of pregnancies (n=7/80), and was denied in 35% of cases (n=28/80), half of the time by anesthesiologists (n=15/80). Patients refused epidural in 13 pregnancies (16%, n=13/80). A general anesthesia was used in six pregnancies (8%, n=6/80), for c-sections only. Back pain was reported in 48% of the pregnancies (n=38/80). The level of fusion was correlated with c-section, and conversely with epidural anesthesia.
A normal pregnancy with vaginal delivery seems to be the rule for women undergoing spinal fusion for AIS. The c-section rate in AIS women was similar to the general population (19%). Yet, access to epidural anesthesia still seems problematic with only 49% of births in this series, compared with 81% in the French population.
IV, retrospective cohort.
青少年特发性脊柱侧凸（AIS）是一种常见的脊柱疾病，影响 2%的青少年，其中 90%为女性。当选择手术治疗时，许多家庭和患者经常会询问脊柱融合后妊娠和分娩的情况。这个问题在文献中研究较少，尤其是在采用现代器械技术的情况下。
本研究旨在描述 AIS 手术后妊娠和分娩的情况，包括硬膜外镇痛的可及性、剖宫产（c-section）的需求以及妊娠和分娩期间及之后的腰痛。因此，我们假设接受脊柱手术治疗 AIS 的女性随后妊娠和分娩较为顺利，可以像没有 AIS 的女性一样获得硬膜外镇痛。
在这项回顾性多中心研究中，我们对 1984 年至 2014 年间在两所大学医院接受手术的 198 名女性进行了回顾性分析。其中，50 名女性怀孕，共 80 例妊娠。收集手术数据[入路、最上和最下置钉椎骨（UIV、LIV）]。评估妊娠特征：手术与妊娠之间的时间、分娩次数、镇痛方式、分娩方式、体重增加。使用 ODI 记录妊娠和随访期间腰痛的发生情况。
50 名女性中，34 名接受后路手术，16 名接受前路手术。分娩时间为 1988 年至 2018 年。80 例妊娠中，81%（n=65/80）经阴道分娩，其中 49%（n=39/80）有效实施了硬膜外镇痛。9%（n=7/80）的妊娠硬膜外镇痛失败，35%（n=28/80）拒绝使用硬膜外镇痛，其中一半（n=15/80）是麻醉师拒绝。13 例（16%，n=13/80）妊娠患者拒绝硬膜外镇痛。6 例（8%，n=6/80）妊娠采用全麻，仅用于剖宫产。48%（n=38/80）的妊娠报告有腰痛。融合水平与剖宫产相关，与硬膜外镇痛呈负相关。
对于接受脊柱融合术治疗 AIS 的女性，正常的阴道分娩妊娠似乎是常规。AIS 女性的剖宫产率与一般人群相似（19%）。然而，与法国人群的 81%相比，本系列中只有 49%的分娩可以使用硬膜外镇痛，这一情况似乎仍然存在问题。
IV，回顾性队列研究。
