Pregnant adolescent idiopathic scoliosis patients with prior fusion are more often recommended cesarian section delivery, without clear differences in maternal or fetal complications: a retrospective matched-cohort analysis.

Abstract

Women with adolescent idiopathic scoliosis (AIS) who have undergone posterior spinal fusion (PSF) prior to conception may have altered pregnancy courses. The current study aimed to evaluate female AIS patients with, relative to without, prior PSF for rates of cesarian (C)-section and pregnancy-related complications at a national level. First-time pregnancies in female AIS patients were identified using the 2010 - Q1 2023 PearlDiver M170 database. Patients were stratified by prior PSF status (AIS[-]PSF versus AIS[ +]PSF) and matched 4:1 based on age and comorbidity burden. Pregnancy outcomes including vaginal delivery, C-section, and conversion from vaginal delivery to C-section (unplanned C-section) were compared using multivariate analyses. Additionally, vaginal delivery and C-section patients were stratified and separately matched 4:1 by PSF status and compared for maternal and fetal complications. In matched cohorts (AIS[-]PSF, n = 2,623; AIS[ +]PSF, n = 656), those with prior PSF were more likely to deliver by C-section (OR 1.61, p < 0.001), but not more likely to undergo unplanned C-section. The incidence of all studied maternal or fetal complications during pregnancy and delivery was not statistically different for vaginal delivery or C-section regardless of PSF status (p > 0.05 for all). Among women with AIS, prior posterior spinal fusion is associated with higher rates of cesarean delivery but not with increased maternal or fetal complications, suggesting that vaginal delivery may be safely considered when otherwise clinically appropriate. Level III.