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Pregnancy & Scoliosis

The effects of pregnancy on patients who have idiopathic scoliosis were investigated in terms of increased risk of progression of the curve. The charts, radiographs, and other pertinent data on 355 affected women who had reached skeletal maturity (Risser Grade 4) before 1975 were reviewed and analyzed. One hundred and seventy-five patients had had at least one pregnancy each (Group A) and 180 patients had never been pregnant (Group B). The groups were comparable with regard to the treatments that they had received. After skeletal maturity was reached, the curve progressed more than 5 degrees in 25 per cent and more than 10 degrees in 10 per cent of the patients in each group.

The age of the patient at the time of the first pregnancy did not influence the risk of progression, and the stability of the curve before pregnancy did not decrease the risk of its progression during pregnancy. In patients who had had a spinal fusion, progression in the unfused portion of the spine was negligible in both Group A and Group B. The presence of a pseudarthrosis did not result in progression of the curve during pregnancy. The effects of scoliosis on pregnancy and delivery were evaluated in the 175 women in Group A. No specific problems that were directly related to the scoliosis were noted except for four patients, in whom delivery posed difficulties. The incidence of cesarean section was one-half of the national average, and no sections were directly related to the mother's scoliosis.

Betz-RR; Bunnell-WP; Lambrecht-Mulier-E; MacEwen-GD J-Bone-Joint-Surg-Am. 1987 Jan; 69(1): 90-6

WP Blount and D Mellencamp

To study the effect of pregnancy on idiopathic scoliosis, ten patients were followed through nineteen pregnancies. Three patients lost 2, 6, and 18 degrees of correction during their initial pregnancies, but the curves remained the same or improved with later pregnancies. The curves of the remaining seven patients, which had stabilized before conception, did not progress. The stability of the scoliosis was not related to the age of the patient. Stable scoliotic curves did not progress with pregnancy in patients in the second decade of life, while unstable scolioses progressed in patients as old as the third decade. The amount that the curve increased was not associated with the initial size of the curve. We hope that our experience will aid orthopaedists in counseling their patients regarding the effect of pregnancy on the magnitude of scoliosis.

Back Pain and Pregnancy: Active Management Strategies - Julie Colliton, MD

In Brief: For about half of all pregnant women, low-back pain is inevitable. Physicians who can specify what type of back pain the patient has--lumbar, sacroiliac, or nocturnal--can institute targeted treatment that addresses the relevant pathophysiology. Acetaminophen and certain modalities such as icing the area are the basis of acute treatment in conjunction with ergonomic adaptation and a good low-back exercise program. This will help decrease stress on the low back, making back pain less likely. Before a woman becomes pregnant, encouraging her to become fit and resolving existing back problems is the key to back pain prevention.

If the discomfort of back pain during pregnancy can be severe enough to warrant sick days and disrupt sleep, it's easy to deduce that it could be an obstacle to activity for women who want to reap the health benefits of exercise during pregnancy. In the past, women were told that biomechanical low-back pain was simply part of pregnancy. Now, though, it is known that the causes of low-back pain during pregnancy are specific and that effective treatment should be geared toward the precise pathology.

Formal study of the incidence of low-back pain in pregnancy has been very limited. The overall prevalence of back pain during the 9-month period is thought to be approximately 50%. Pain can begin before week 12 and continue up to 6 months postpartum.

Various studies have examined the risk factors that contribute to the development of low-back pain during pregnancy. Prepregnancy back pain and multiparity seem to be risk factors, whereas age, height, weight, race, fetal weight, and socioeconomic status do not seem to correlate.

Low-back pain during pregnancy can be classified into three types:

  • Lumbar pain can occur with or without radiation to the legs. True sciatica is rare and thought to account for a small percentage of low-back pain in pregnancy.
  • Sacroiliac pain is felt distal and lateral to the lumbar spine near the posterior superior iliac spine, and may radiate to the posterolateral thigh, usually to the level of the knee and rarely to the calf. It is four times more common than lumbar pain.
  • Symptoms of sacroiliac joint pain typically continue several months after delivery. It is thought that 20% to 30% of pregnant women experience both lumbar and sacroiliac pain. Nocturnal pain occurs in the low back only at night while recumbent.

Why Does Her Back Hurt?
Understanding the normal musculoskeletal changes that occur during pregnancy is useful for targeting and treating the sites of a patient's back pain.

Lumbar pain. Lumbar pain during pregnancy can stem from multiple sites, most commonly the facet joints, paraspinal muscles, supporting ligaments, or discogenic sources.

Posture changes that occur during pregnancy help the woman maintain balance in the upright position as the fetus grows. The increasing weight is distributed primarily in the abdominal girth. After 12 weeks of pregnancy the uterus expands out of the pelvis and moves superiorly, anteriorly, and laterally. The abdominal muscles become less effective at maintaining neutral posture (shoulders back, avoiding hyperlordosis) because the growing uterus stretches the muscles, reducing their tone. Initially, however, studies have shown that lumbar lordosis remains the same or increases only slightly.The center of gravity as a whole, though, shifts more posteriorly and inferiorly as the spine moves posterior to the center of gravity.

As pregnancy progresses, the hormone relaxin, which allows pelvic expansion to accommodate the enlarging uterus, increases tenfold, reaching its peak at the 14th week. Joint laxity is more pronounced in multiparous women than it is during the first pregnancy. In the lumbar spine, joint laxity is most notable in the anterior and posterior longitudinal ligaments, both of which are pain-sensitive structures. As these static supports in the lumbar spine become more lax, they can't as effectively withstand shear forces, and discogenic symptoms and/or pain from the facet joints may increase.

As the abdominal muscles stretch to accommodate the growing fetus, their ability to help stabilize the pelvis decreases. The burden shifts to the paraspinal muscles, which become strained at a time when they may be shortened from the increased lordosis of the lumbar spine.

Sacroiliac pain. In the pelvis, joint laxity is most prominent in the symphysis pubis and the sacroiliac joints. The symphysis pubis widens throughout pregnancy from its normal width of .5 mm to a maximum of approximately 12 mm. With widening comes the possibility of vertical displacement of the pubis and rotatory stress on the sacroiliac joints.

In the nonpregnant state, the sacroiliac joints are extremely stable with tight anterior and posterior ligament support and a sigmoid articular surface that limits movement. During pregnancy, however, movement in the sacroiliac joints can increase dramatically, causing discomfort when the pain-sensitive ligamentous structures are stretched.

Nocturnal pain. Some women have night back pain exclusively, others have both night pain and lumbar or sacroiliac pain. There are many theories about why night pain develops. One theory is that muscle fatigue accumulates throughout the day and culminates in back pain at night. Another is that daylong biomechanical stress from sacroiliac dysfunction or mechanical low-back pain from altered posture produces symptoms in the evening. Circulatory changes during pregnancy may also contribute to low-back pain at night.

Extracted from 'Back Pain During Pregnacy'

Dear Toni,
Unfortunately, many women experience lower back pain during pregnancy. I can truly empathize with your condition. Luckily, I didn't need a TENS unit during my own pregnancies, but at times I was close. It will get better once you deliver, but that clearly is a ways away. Apply heat. Many women are afraid of heat during pregnancy; however, you would really have to fry yourself to damage the child. Try sitting in a warm tub or jacuzzi. You don't want the water too hot, but a nice 100 F tub will work wonders.

Wear a support gadget. There are abdominal support straps (they look like school crossing guard straps) that help support the pregnant uterus. These may help you move more freely. Also, if you have access to a swimming pool, go for it -- swimming is wonderful exercise for pregnancy, and water will also help support your pregnant uterus. Do strengthening exercises. Pelvic-tilt exercises help strengthen the back, relieving pain. And, often, just putting yourself into the knee-chest position to get the baby out of the pelvis and off of your pelvic nerves may make you more comfortable.

Take medications cautiously. Certain medications can be used safely during pregnancy. Although I discourage my patients from taking non-steroidal anti-inflammatories during pregnancy, tylenol in standard doses is allowable. For severe pain, narcotics such as codeine will not hurt the baby. The good news is that I have not found that labor is significantly worse for women with bad backs, and very rarely do back problems prevent the use of the epidural anesthesia. Remember, there is an end in sight!