Outcomes of pregnancy in operative vs. nonoperative adolescent idiopathic scoliosis patients at mean 30-year follow-up

Study designRetrospective cohort study.ObjectiveTo determine whether patients who underwent surgical treatment of adolescent idiopathic scoliosis (AIS) in childhood would have an increased C-section risk in adulthood.Summary of background dataAlthough the impact of scoliosis on future pregnancy and child delivery is a common question for patients and parents, there is limited data regarding pregnancy outcomes following childhood treatment of AIS.MethodsBetween 1975 and 1992, 60 female patients underwent treatment for AIS with bracing, surgery, or observation and had data available regarding obstetrical history in the electronic medical record or in paper charts. In childhood, 28 had nonoperative treatment and 32 had fusion surgery. During the follow-up period, 2 nonoperative patients and 1 operative patient had fusion surgery in adulthood, but after childbearing years. Mean age at latest follow-up was 43 years (CI 38, 48). Meantime to follow-up since childhood treatment was 31 years (CI 26, 35).Results29% of nonoperative patients had a C-section with at least one live birth compared to 38% of operative patients (p=0.464). For surgical patients fused to L3 or lower, 46% required at least one C-section, compared to 32% of patients fused to L2 or higher (p=0.40). Overall, 33% of the cohort of patients-including those with all scoliosis treatment methods-required at least one C-section, compared to the state weighted C-section rate of 20.5% (p=0.014). The percentage of patients with operative treatment-including all levels of fusion-requiring at least one C-section was statistically different than the weighted state C-section rate (p=0.020).ConclusionIn this long-term cohort of 60 US scoliosis patients, childhood operative fusion treatment was associated with a statistically significant increased incidence of C-section compared to the state incidence at both the patient level and the delivery level.Level of evidenceIII, comparative cohort study