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“I have had scoliosis surgery. Do I face any risks with pregnancy?”

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Let’s imagine the case of a healthy, active young woman who, as a teenager, had challenging scoliosis treatment, to the point of requiring surgery. Now, a few years on, she faces a new challenge: she wishes to become pregnant in order to fulfil her dreams of becoming a mother. 

Pregnancy is a period that naturally brings worries as well as lots of new information that needs to absorbed in order to be able to enjoy this special time. Those with scoliosis might start wondering “Will I have problems in pregnancy because of my scoliosis and the surgery I had? Or the reverse: “Could pregnancy aggravate my back condition?”.

Let’s try and help this mother-to-be, by providing answers based on the best available scientific evidence.

Several studies in the literature have investigated the topic “Pregnancy and surgery”, examining how one might influence the other.
Let us begin by underlining one reassuring aspect: as far as has been demonstrated so far, pregnancy (be it one pregnancy or more) has no consequences (in terms of a progression or deterioration of the curve) either on the surgically fused portion of the spine or on the vertebrae that were left free (https://pubmed.ncbi.nlm.nih.gov/32272267/;  https://pubmed.ncbi.nlm.nih.gov/2948962/). 

Nevertheless, it is always a good idea, when possible, to seek the opinion of the surgeon who performed the surgery, in order to have answers to your queries and precise instructions to follow.

Moreover, if the patient chooses epidural pain relief and/or chooses or requires to deliver by caesarean section with epidural anaesthesia, the anaesthetist might wish to avoid the surgically-treated portion of the spine (https://pubmed.ncbi.nlm.nih.gov/32578160/ ; https://pubmed.ncbi.nlm.nih.gov/30610987/ ), even though this decision by the medical team, made in agreement with the patient, seems to be taken more as a precaution.

In general, the use of epidurals in women with previous scoliosis surgery is comparable to what is observed in scoliosis patients who have not had operative treatment. Furthermore, according to the available data, anaesthesiologists seem reluctant to perform an epidural if the surgically treated portion of the column is below the third lumbar vertebra, preferring instead to opt for general anaesthesia (https://pubmed.ncbi.nlm.nih.gov/26131384/ ; https://pubmed.ncbi.nlm.nih.gov/32578160/ ; https://pubmed.ncbi.nlm.nih.gov/30610987/ ).

With regard to possible pain or complications during pregnancy and delivery, some studies have shown that there are no differences between women who have and those who have not had scoliosis surgery (https://pubmed.ncbi.nlm.nih.gov/9391799/ ).
On the other hand, low back pain during pregnancy seems to be more frequent in surgically treated patients, although it disappears relatively quickly after delivery. ( https://pubmed.ncbi.nlm.nih.gov/30610987/ ).
All in all, then, a mother-to-be can face this exciting new chapter in her life with complete peace of mind, even though she should not forget to seek the opinion, regarding her back, of both her family doctor and a spine specialist. In this way, it is possible to prevent any pain and have the best possible experience of pregnancy and childbirth

Returning to physical activity after surgery for adolescent idiopathic scoliosis

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Sport and physical activity are essential for psychosocial and physical well-being in children and adolescents, and youngsters with scoliosis are not subject to any limitations in this regard: they can do sports and other physical activities just like their peers can.

In severe scoliosis, i.e., in individuals with curves measuring more than 50° and presenting significant aesthetic and developmental deformities despite undergoing orthotic/bracing treatment properly administered according to the SOSORT criteria, surgery is indicated. 

“In some cases, patients who undergo corrective surgery for scoliosis may reduce their level of physical activity postoperatively due to a loss of spinal flexibility and pain. This inevitably impacts negatively on their quality of life – says dr Carmelo Pulici, physiatrist – No guidelines have yet been published on the resumption of physical activity after surgery for adolescent idiopathic scoliosis, and “expert opinion” is therefore all we have to rely on. Consequently, different surgeons may give different indications, depending on their experience and the particular type of approach”.

There are also individual factors at play, and the decision to resume physical activity may therefore depend on: the type of surgery performed, how the body responds and adapts to the metal rods inserted to correct the spine, the extent of the fusion, how recently the surgery was carried out, the characteristics of the patient, and also the type of sport practised (non-contact, contact or collision).  

For example, while some surgeons allow contact sports to be resumed six months after surgery, others recommend waiting a year, and some even rule out the resumption of collision sports altogether (https://pubmed.ncbi.nlm.nih.gov/26920125/). 

“In one study, return to sport/physical activities after surgery was examined using a specially created questionnaire (https://pubmed.ncbi.nlm.nih.gov/28604495/). By six months, most patients had returned to the activities they did before the surgery” – explains Dr Pulici. “The authors found that patients returned to athletics much earlier than expected. Despite this, there were no cases of loss of correction, implant failure or complications among the 95 patients included in the study”. 

A new surgical technique

In recent years, there has been a growing interest in vertebral body tethering (VBT), a new surgical technique used only in children and in early adolescence and, even then, only in carefully selected patients, given that the method is still experimental. VBT is proposed as a possible alternative to spinal fusion (currently the most widely used technique for the surgical treatment of scoliosis). Unlike spinal fusion, it does not reduce the mobility of the spine. 

“According to a recent study, VBT allows daily activities and sports to be resumed within three months of the surgery” Dr Pulici goes on. “Furthermore, most of the patients examined in the study reported an improvement in their athletic performance, and some were found to be doing more sports than before undergoing VBT”.

Even though surgeons today tend to allow patients to return to sports (even high-intensity ones) earlier than in the past (https://pubmed.ncbi.nlm.nih.gov/34267153/), we are still a long way from seeing a common approach to the management of postoperative resumption of physical activity in this patient population.

In the absence of guidelines, we at Isico recommend that patients turn to an experienced therapist in the post-operative period to ensure a gradual and safe return to physical activity, obviously following the instructions received from their surgeon.

It is important to avoid falling into the vicious cycle of a sedentary lifestyle. The less active you are, the less you feel inclined to do physical activity and the greater the risks to your health due to your lack of movement.