Balancing Scoliosis History and Birthing Plans

For women who underwent spinal surgery during adolescence, approaching pregnancy often brings unique questions about labor and delivery. A common concern is whether a spinal fusion impacts the ability to have a natural birth.

Adolescent idiopathic scoliosis is a sideways curvature of the spine that develops during puberty. When the curve is severe, orthopedic surgeons often fuse a portion of the spine. This procedure uses metal rods and bone grafts to permanently connect and straighten the vertebrae. While this effectively corrects the posture, it can also limit the flexibility of the spine.

Historically, doctors and patients alike have worried that this lack of spinal and pelvic mobility could make natural childbirth difficult or unsafe. However, a Yale study published in the journal Spine Deformity found that vaginal delivery can be just as safe as cesarian (C)-section, offering reassuring news for expectant mothers who have previously undergone scoliosis surgery.

A team of Yale orthopedic and obstetric researchers set out to determine if a history of spinal fusion leads to more C-sections or a higher rate of complications. Prior studies on this topic were small and often tracked fewer than 100 patients from a single hospital. This left doctors with conflicting information and no clear guidelines.

The multidisciplinary team of researchers analyzed a national health database containing records for nearly 170 million orthopedic patients in the United States. They identified over 38,000 women with adolescent idiopathic scoliosis who gave birth to their first child.

Researchers compared pairs of patients, matching those who had the spinal surgery with patients who did not, ensuring both were identical in age and overall health complexity. This method allowed investigators to isolate the true impact of the spinal surgery on birth outcomes.

The findings revealed a distinct trend. Women who had undergone spinal fusion were significantly more likely to deliver via C-section compared to those who managed their scoliosis without surgery.

"When we looked at the data, the numbers clearly showed that women with a history of spinal fusion undergo C-sections at a much higher rate," says associate professor Dominick Tuason, MD, an investigator on the study and a pediatric orthopedic spine surgeon. "However, the most critical takeaway is what happened when we looked closer at the complication rates. Despite the higher number of surgical deliveries, there was no increase in unplanned or emergency C-sections among the spinal fusion group.”

Researchers also found no difference in maternal or fetal complications between the two groups. Whether the women delivered vaginally or by C-section, the health outcomes for both mothers and their babies were virtually identical, regardless of their spinal surgery history.

“If vaginal deliveries are entirely safe for these patients, why are C-sections so much more common?” Tuason asks. "The lack of physical complications indicates that this spike in C-sections isn't biologically driven. Instead, it likely reflects a hesitation or misconception among healthcare providers that a stiffened spine limits a woman’s ability to give birth naturally."

While C-sections are vital and lifesaving when necessary, they are major surgeries that carry inherent risks. For mothers, a C-section means a longer recovery time and a higher chance of infection. For newborns, it can occasionally lead to temporary breathing issues. Understanding that the avenue of natural delivery can safely be pursued allows families to avoid unnecessary surgical risks.

Tuason notes that the goal of this research is to adapt how doctors counsel young women from adolescence through adulthood. While the final decision regarding delivery always takes place between the patient and the obstetrician, the advice given by orthopedic surgeons during youth can shape lifelong expectations and experiences.

This research suggests that vaginal delivery can be safely considered for scoliosis patients with prior spinal fusions, assuming there are no other routine obstetric reasons to avoid it.

"Spine surgeons play a major role in how these young women view their future physical capabilities," Tuason says. "One of the best ways we can use this data is to reassure our patients that a spinal fusion in your teenage years does not mean you are locked into a surgical delivery down the road."

In addition to Tuason, the co-authors include: Alexandros Pappajohn; Anthony Seddio, MD; Om Jahagirdar; Wasif Islam, MD; Sahir Jabbouri, MD; Mert Bahtiyar, MD; and senior author Jonathan Grauer, MD.