Nandoliya Khizar R, Sadagopan Nishanth S, Alwakeal Amr, Kemeny Hanna, Cloney Michael, Dahdaleh Nader S, Koski Tyler, El Tecle Najib
Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA.
Cureus. 2023 Oct 10;15(10):e46782. doi: 10.7759/cureus.46782. eCollection 2023 Oct.
Objective This study examined the interaction between adolescent idiopathic scoliosis (AIS) and pregnancy, focusing on pregnancy outcomes, changes in back pain, and anesthesia use. Methods A retrospective analysis was conducted on adult patients with AIS who gave birth at our institution between 2006 and 2022. Results A total of 163 AIS patients with 263 pregnancies were included. The median age at delivery was 33 (range 18 to 50) years. Among 157 patients with information on prior scoliosis treatment, 66.9% had not received treatment, 20.4% had undergone spinal fusion, and 12.7% had received bracing. Of the 260 pregnancies with available data, 90.4% were delivered at term and 8.5% were preterm. Of the 257 pregnancies with information on anesthesia type, 35.0% received epidural anesthesia, 17.9% received spinal anesthesia, 37.7% received combined spinal and epidural anesthesia, 8.2% received no anesthesia, and 1.2% received intravenous or general anesthesia. Difficulty administering neuraxial anesthesia was reported in 6.1% of cases, and these patients were less likely to receive combined spinal and epidural anesthesia (6.3% versus 39.8%, p = 0.0123). Among 116 cases with recorded back pain during pregnancy, 67.2% reported increased pain, 31.9% reported similar pain, and one patient reported decreased pain. Of the 16 patients with pre and postpartum radiographs, eight showed a Cobb angle increase ≥ 3°, with five patients having an increase ≥ 5°. Conclusions Pregnancy can exacerbate back pain and pose challenges for neuraxial anesthesia in some AIS patients. Further large-scale, multi-institutional studies with standardized data collection are needed to fully understand the impact of pregnancy on AIS.
目的 本研究探讨青少年特发性脊柱侧凸（AIS）与妊娠之间的相互作用，重点关注妊娠结局、背痛变化及麻醉使用情况。方法 对2006年至2022年在本机构分娩的成年AIS患者进行回顾性分析。结果 共纳入163例AIS患者的263次妊娠。分娩时的中位年龄为33岁（范围18至50岁）。在157例有既往脊柱侧凸治疗信息的患者中，66.9%未接受治疗，20.4%接受了脊柱融合术，12.7%接受了支具治疗。在260例有可用数据的妊娠中，90.4%足月分娩，8.5%早产。在257例有麻醉类型信息的妊娠中，35.0%接受硬膜外麻醉，17.9%接受蛛网膜下腔麻醉，37.7%接受腰麻-硬膜外联合麻醉，8.2%未接受麻醉，1.2%接受静脉或全身麻醉。6.1%的病例报告了椎管内麻醉给药困难，这些患者接受腰麻-硬膜外联合麻醉的可能性较小（6.3%对39.8%，p = 0.0123）。在116例妊娠期间记录有背痛的病例中，67.2%报告疼痛加重，31.9%报告疼痛相似，1例患者报告疼痛减轻。在16例有产前和产后X线片的患者中，8例显示Cobb角增加≥3°，5例患者增加≥5°。结论 妊娠可加重部分AIS患者的背痛，并给椎管内麻醉带来挑战。需要进一步开展大规模、多机构、数据收集标准化的研究，以全面了解妊娠对AIS的影响。
