Pregnancy and Childbirth After Spinal Fusion for Adolescent Idiopathic Scoliosis

Matthew Landrum; Heidi R. Nocka; Leta Ashebo; Didja Hilmara; Elle MacAlpine; John M. Flynn; Michelle Ho; Peter O. Newton; Paul D. Sponseller; Baron S. Lonner; Patrick J. Cahill; Aaron Buckland; Amer Samdani; Amit Jain; Baron Lonner; Benjamin Roye; Burt Yaszay; Chris Reilly; Daniel Hedequist; Daniel Sucato; David Clements; Firoz Miyanji; Harry Shufflebarger; Jack Flynn; John Asghar; Jean Marc Mac Thiong; Joshua Pahys; Juergen Harms; Keith Bachmann; Lawrence Lenke; Lori Karol; Mark Abel; Mark Erickson; Michael Glotzbecker; Michael Kelly; Michael Vitale; Michelle Marks; Munish Gupta; Nicholas Fletcher; Noelle Larson; Patrick Cahill; Peter Gabos; Peter Newton; Peter Sturm; Randal Betz; Stefan Parent; Stephen George; Steven Hwang; Suken Shah; Sumeet Garg; Tom Errico; Vidyadhar Upasani

doi:10.1097/BPO.0000000000002499

Pregnancy and Childbirth After Spinal Fusion for Adolescent Idiopathic Scoliosis

Matthew Landrum, Heidi R. Nocka, Leta Ashebo, Didja Hilmara, Elle MacAlpine, John M. Flynn, Michelle Ho, Peter O. Newton, Paul D. Sponseller, Baron S. Lonner, Patrick J. Cahill, Aaron Buckland, Amer Samdani, Amit Jain, Baron Lonner, Benjamin Roye, Burt Yaszay, Chris Reilly, Daniel Hedequist, Daniel SucatoDavid Clements, Firoz Miyanji, Harry Shufflebarger, Jack Flynn, John Asghar, Jean Marc Mac Thiong, Joshua Pahys, Juergen Harms, Keith Bachmann, Lawrence Lenke, Lori Karol, Mark Abel, Mark Erickson, Michael Glotzbecker, Michael Kelly, Michael Vitale, Michelle Marks, Munish Gupta, Nicholas Fletcher, Noelle Larson, Patrick Cahill, Peter Gabos, Peter Newton, Peter Sturm, Randal Betz, Stefan Parent, Stephen George, Steven Hwang, Suken Shah, Sumeet Garg, Tom Errico, Vidyadhar Upasani

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Little data exist on pregnancy and childbirth for adolescent idiopathic scoliosis (AIS) patients treated with a spinal fusion. The current literature relies on data from patients treated with spinal fusion techniques and instrumentation, such as Harrington rods, that are no longer in use. The objective of our study is to understand the effects of spinal fusion in adolescence on pregnancy and childbirth. Methods: Prospectively collected data of AIS patients undergoing posterior spinal fusion that were enrolled in a multicenter study who have had a pregnancy and childbirth were reviewed. Results were summarized using descriptive statistics and compared with national averages using χ² test of independence. Results: A total of 78 babies were born to 53 AIS patients. As part of their pre-natal care, 24% of patients surveyed reported meeting with an anesthesiologist before delivery. The most common types of delivery were spontaneous vaginal delivery (46%, n=36/78) and planned cesarean section (20%, n=16/78). Compared with the national average, study patients had a higher rate of cesarean delivery (P=0.021). Of the women who had a spontaneous vaginal birth, 53% had no anesthesia (n=19/36), 19% received intravenous intermittent opioids (n=7/36), and 31% had regional spinal or epidural anesthesia (n=11/36). spontaneous vaginal delivery patients in our study cohort received epidural or spinal anesthesia less frequently than the national average (P<0.001). Of those (n=26 pregnancies) who did not have regional anesthesia (patients who had no anesthesia or utilized IV intermittent opioids), 19% (n=5 pregnancies) were told by their perinatal providers that it was precluded by previous spine surgery. Conclusion: The majority of AIS patients reported not meeting with an anesthesiologist before giving birth and those who had a planned C-section did so under obstetrician recommendation. The presence of instrumentation after spinal fusion should be avoided with attempted access to the spinal canal but should not dictate a delivery plan. A multidisciplinary team consisting of obstetrician, anesthesiologist, and orthopaedic surgeon can provide the most comprehensive information to empower a patient to make her decisions regarding birth experience anesthesia based on maternal rather than provider preference.

Original language	English (US)
Pages (from-to)	620-625
Number of pages	6
Journal	Journal of Pediatric Orthopaedics
Volume	43
Issue number	10
DOIs	https://doi.org/10.1097/BPO.0000000000002499
State	Published - Nov 1 2023

Keywords

Adolescent idiopathic scoliosis (AIS)
anesthesia
childbirth
delivery
pregnancy
spinal fusion

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health
Orthopedics and Sports Medicine

Access to Document

10.1097/BPO.0000000000002499

Cite this

Landrum, M., Nocka, H. R., Ashebo, L., Hilmara, D., MacAlpine, E., Flynn, J. M., Ho, M., Newton, P. O., Sponseller, P. D., Lonner, B. S., Cahill, P. J., Buckland, A., Samdani, A., Jain, A., Lonner, B., Roye, B., Yaszay, B., Reilly, C., Hedequist, D., ... Upasani, V. (2023). Pregnancy and Childbirth After Spinal Fusion for Adolescent Idiopathic Scoliosis. Journal of Pediatric Orthopaedics, 43(10), 620-625. https://doi.org/10.1097/BPO.0000000000002499

Landrum, M, Nocka, HR, Ashebo, L, Hilmara, D, MacAlpine, E, Flynn, JM, Ho, M, Newton, PO, Sponseller, PD, Lonner, BS, Cahill, PJ, Buckland, A, Samdani, A, Jain, A, Lonner, B, Roye, B, Yaszay, B, Reilly, C, Hedequist, D, Sucato, D, Clements, D, Miyanji, F, Shufflebarger, H, Flynn, J, Asghar, J, Mac Thiong, JM, Pahys, J, Harms, J, Bachmann, K, Lenke, L, Karol, L, Abel, M, Erickson, M, Glotzbecker, M, Kelly, M, Vitale, M, Marks, M, Gupta, M, Fletcher, N, Larson, N, Cahill, P, Gabos, P, Newton, P, Sturm, P, Betz, R, Parent, S, George, S, Hwang, S, Shah, S, Garg, S, Errico, T & Upasani, V 2023, 'Pregnancy and Childbirth After Spinal Fusion for Adolescent Idiopathic Scoliosis', Journal of Pediatric Orthopaedics, vol. 43, no. 10, pp. 620-625. https://doi.org/10.1097/BPO.0000000000002499

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title = "Pregnancy and Childbirth After Spinal Fusion for Adolescent Idiopathic Scoliosis",

abstract = "Background: Little data exist on pregnancy and childbirth for adolescent idiopathic scoliosis (AIS) patients treated with a spinal fusion. The current literature relies on data from patients treated with spinal fusion techniques and instrumentation, such as Harrington rods, that are no longer in use. The objective of our study is to understand the effects of spinal fusion in adolescence on pregnancy and childbirth. Methods: Prospectively collected data of AIS patients undergoing posterior spinal fusion that were enrolled in a multicenter study who have had a pregnancy and childbirth were reviewed. Results were summarized using descriptive statistics and compared with national averages using χ2 test of independence. Results: A total of 78 babies were born to 53 AIS patients. As part of their pre-natal care, 24% of patients surveyed reported meeting with an anesthesiologist before delivery. The most common types of delivery were spontaneous vaginal delivery (46%, n=36/78) and planned cesarean section (20%, n=16/78). Compared with the national average, study patients had a higher rate of cesarean delivery (P=0.021). Of the women who had a spontaneous vaginal birth, 53% had no anesthesia (n=19/36), 19% received intravenous intermittent opioids (n=7/36), and 31% had regional spinal or epidural anesthesia (n=11/36). spontaneous vaginal delivery patients in our study cohort received epidural or spinal anesthesia less frequently than the national average (P<0.001). Of those (n=26 pregnancies) who did not have regional anesthesia (patients who had no anesthesia or utilized IV intermittent opioids), 19% (n=5 pregnancies) were told by their perinatal providers that it was precluded by previous spine surgery. Conclusion: The majority of AIS patients reported not meeting with an anesthesiologist before giving birth and those who had a planned C-section did so under obstetrician recommendation. The presence of instrumentation after spinal fusion should be avoided with attempted access to the spinal canal but should not dictate a delivery plan. A multidisciplinary team consisting of obstetrician, anesthesiologist, and orthopaedic surgeon can provide the most comprehensive information to empower a patient to make her decisions regarding birth experience anesthesia based on maternal rather than provider preference.",

keywords = "Adolescent idiopathic scoliosis (AIS), anesthesia, childbirth, delivery, pregnancy, spinal fusion",

author = "Matthew Landrum and Nocka, {Heidi R.} and Leta Ashebo and Didja Hilmara and Elle MacAlpine and Flynn, {John M.} and Michelle Ho and Newton, {Peter O.} and Sponseller, {Paul D.} and Lonner, {Baron S.} and Cahill, {Patrick J.} and Aaron Buckland and Amer Samdani and Amit Jain and Baron Lonner and Benjamin Roye and Burt Yaszay and Chris Reilly and Daniel Hedequist and Daniel Sucato and David Clements and Firoz Miyanji and Harry Shufflebarger and Jack Flynn and John Asghar and {Mac Thiong}, {Jean Marc} and Joshua Pahys and Juergen Harms and Keith Bachmann and Lawrence Lenke and Lori Karol and Mark Abel and Mark Erickson and Michael Glotzbecker and Michael Kelly and Michael Vitale and Michelle Marks and Munish Gupta and Nicholas Fletcher and Noelle Larson and Patrick Cahill and Peter Gabos and Peter Newton and Peter Sturm and Randal Betz and Stefan Parent and Stephen George and Steven Hwang and Suken Shah and Sumeet Garg and Tom Errico and Vidyadhar Upasani",

year = "2023",

month = nov,

day = "1",

doi = "10.1097/BPO.0000000000002499",

language = "English (US)",

volume = "43",

pages = "620--625",

journal = "Journal of Pediatric Orthopaedics",

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publisher = "Lippincott Williams and Wilkins",

number = "10",

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TY - JOUR

T1 - Pregnancy and Childbirth After Spinal Fusion for Adolescent Idiopathic Scoliosis

AU - Landrum, Matthew

AU - Nocka, Heidi R.

AU - Ashebo, Leta

AU - Hilmara, Didja

AU - MacAlpine, Elle

AU - Flynn, John M.

AU - Ho, Michelle

AU - Newton, Peter O.

AU - Sponseller, Paul D.

AU - Lonner, Baron S.

AU - Cahill, Patrick J.

AU - Buckland, Aaron

AU - Samdani, Amer

AU - Jain, Amit

AU - Lonner, Baron

AU - Roye, Benjamin

AU - Yaszay, Burt

AU - Reilly, Chris

AU - Hedequist, Daniel

AU - Sucato, Daniel

AU - Clements, David

AU - Miyanji, Firoz

AU - Shufflebarger, Harry

AU - Flynn, Jack

AU - Asghar, John

AU - Mac Thiong, Jean Marc

AU - Pahys, Joshua

AU - Harms, Juergen

AU - Bachmann, Keith

AU - Lenke, Lawrence

AU - Karol, Lori

AU - Abel, Mark

AU - Erickson, Mark

AU - Glotzbecker, Michael

AU - Kelly, Michael

AU - Vitale, Michael

AU - Marks, Michelle

AU - Gupta, Munish

AU - Fletcher, Nicholas

AU - Larson, Noelle

AU - Cahill, Patrick

AU - Gabos, Peter

AU - Newton, Peter

AU - Sturm, Peter

AU - Betz, Randal

AU - Parent, Stefan

AU - George, Stephen

AU - Hwang, Steven

AU - Shah, Suken

AU - Garg, Sumeet

AU - Errico, Tom

AU - Upasani, Vidyadhar

PY - 2023/11/1

Y1 - 2023/11/1

N2 - Background: Little data exist on pregnancy and childbirth for adolescent idiopathic scoliosis (AIS) patients treated with a spinal fusion. The current literature relies on data from patients treated with spinal fusion techniques and instrumentation, such as Harrington rods, that are no longer in use. The objective of our study is to understand the effects of spinal fusion in adolescence on pregnancy and childbirth. Methods: Prospectively collected data of AIS patients undergoing posterior spinal fusion that were enrolled in a multicenter study who have had a pregnancy and childbirth were reviewed. Results were summarized using descriptive statistics and compared with national averages using χ2 test of independence. Results: A total of 78 babies were born to 53 AIS patients. As part of their pre-natal care, 24% of patients surveyed reported meeting with an anesthesiologist before delivery. The most common types of delivery were spontaneous vaginal delivery (46%, n=36/78) and planned cesarean section (20%, n=16/78). Compared with the national average, study patients had a higher rate of cesarean delivery (P=0.021). Of the women who had a spontaneous vaginal birth, 53% had no anesthesia (n=19/36), 19% received intravenous intermittent opioids (n=7/36), and 31% had regional spinal or epidural anesthesia (n=11/36). spontaneous vaginal delivery patients in our study cohort received epidural or spinal anesthesia less frequently than the national average (P<0.001). Of those (n=26 pregnancies) who did not have regional anesthesia (patients who had no anesthesia or utilized IV intermittent opioids), 19% (n=5 pregnancies) were told by their perinatal providers that it was precluded by previous spine surgery. Conclusion: The majority of AIS patients reported not meeting with an anesthesiologist before giving birth and those who had a planned C-section did so under obstetrician recommendation. The presence of instrumentation after spinal fusion should be avoided with attempted access to the spinal canal but should not dictate a delivery plan. A multidisciplinary team consisting of obstetrician, anesthesiologist, and orthopaedic surgeon can provide the most comprehensive information to empower a patient to make her decisions regarding birth experience anesthesia based on maternal rather than provider preference.

AB - Background: Little data exist on pregnancy and childbirth for adolescent idiopathic scoliosis (AIS) patients treated with a spinal fusion. The current literature relies on data from patients treated with spinal fusion techniques and instrumentation, such as Harrington rods, that are no longer in use. The objective of our study is to understand the effects of spinal fusion in adolescence on pregnancy and childbirth. Methods: Prospectively collected data of AIS patients undergoing posterior spinal fusion that were enrolled in a multicenter study who have had a pregnancy and childbirth were reviewed. Results were summarized using descriptive statistics and compared with national averages using χ2 test of independence. Results: A total of 78 babies were born to 53 AIS patients. As part of their pre-natal care, 24% of patients surveyed reported meeting with an anesthesiologist before delivery. The most common types of delivery were spontaneous vaginal delivery (46%, n=36/78) and planned cesarean section (20%, n=16/78). Compared with the national average, study patients had a higher rate of cesarean delivery (P=0.021). Of the women who had a spontaneous vaginal birth, 53% had no anesthesia (n=19/36), 19% received intravenous intermittent opioids (n=7/36), and 31% had regional spinal or epidural anesthesia (n=11/36). spontaneous vaginal delivery patients in our study cohort received epidural or spinal anesthesia less frequently than the national average (P<0.001). Of those (n=26 pregnancies) who did not have regional anesthesia (patients who had no anesthesia or utilized IV intermittent opioids), 19% (n=5 pregnancies) were told by their perinatal providers that it was precluded by previous spine surgery. Conclusion: The majority of AIS patients reported not meeting with an anesthesiologist before giving birth and those who had a planned C-section did so under obstetrician recommendation. The presence of instrumentation after spinal fusion should be avoided with attempted access to the spinal canal but should not dictate a delivery plan. A multidisciplinary team consisting of obstetrician, anesthesiologist, and orthopaedic surgeon can provide the most comprehensive information to empower a patient to make her decisions regarding birth experience anesthesia based on maternal rather than provider preference.

KW - Adolescent idiopathic scoliosis (AIS)

KW - anesthesia

KW - childbirth

KW - delivery

KW - pregnancy

KW - spinal fusion

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Pregnancy and Childbirth After Spinal Fusion for Adolescent Idiopathic Scoliosis

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