Anesthesia management of pregnancy with moderate to severe scoliosis_West China Medical Journal

Authors：

ZHOU Lingjun ,  MA Yushan

Department of Anesthesiology, West China Second University Hospital, Sichuan University / Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

MA Yushan, Email: mayushan_123@163.com

Keywords：

Scoliosis; pregnancy; anaesthesia

DOI：

10.7507/1002-0179.202212143

Video：

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Objective To discuss the characteristics of delivery and anesthesia management of pregnant women with moderate to severe scoliosis, and to summarize the anesthesia implementation strategies for pregnant women with scoliosis. Methods Pregnant women with moderate to severe scoliosis admitted to West China Second University Hospital, Sichuan University between January 2020 and January 2022 were retrospectively included. The demography information, delivery mode, anesthesia implementation plan and other relevant data of the women were analyzed. Results A total of 9 women with moderate to severe scoliosis were included, with an average age of 29.9 years. The median (lower quartile, upper quartile) of the Cobb angle of the women was 42° (35°, 54°). There were 5 women with moderate to severe impairment of lung ventilation function, 1 woman with grade Ⅲ heart function, and 8 women with comorbidities. Among the 8 women who underwent cesarean section, 3 underwent general anesthesia, 4 underwent epidural block, and 1 underwent local anesthesia with enhanced sedation. One woman who chose vaginal delivery underwent epidural labor analgesia. All women passed the surgery or delivery period safely, with 5 transferred to the intensive care unit for further treatment after surgery, and 4 safely returned to the ward after surgery. All women recovered and were discharged. Eight fetuses survived, and 1 fetus underwent lethal induced abortion. Conclusions Pregnant women with moderate to severe scoliosis during pregnancy have poor tolerance to vaginal delivery due to severe malformations and organ dysfunction, especially cardiopulmonary dysfunction. Most of them terminate pregnancy through cesarean section. When making anesthesia decisions, it is important to carefully consider the women’s own condition and surgical risks.

Citation： ZHOU Lingjun, MA Yushan. Anesthesia management of pregnancy with moderate to severe scoliosis. West China Medical Journal, 2023, 38(5): 724-728. doi: 10.7507/1002-0179.202212143 Copy

1.	Negrini S, Donzelli S, Aulisa AG, et al. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord, 2018, 13: 3.
2.	Sharma S, Gao X, Londono D, et al. Genome-wide association studies of adolescent idiopathic scoliosis suggest candidate susceptibility genes. Hum Mol Genet, 2011, 20(7): 1456-1466.
3.	Weinstein SL, Dolan LA, Cheng JC, et al. Adolescent idiopathic scoliosis. Lancet, 2008, 371(9623): 1527-1537.
4.	李雄飞, 陈秀丽, 邵杰, 等. 青少年特发性脊柱侧凸女性患者治疗后生育状况及评估方法研究进展. 海军军医大学学报, 2022, 43(5): 546-549.
5.	彭影, 彭程, 吴大保. 妊娠合并重度脊柱侧凸畸形 6 例分析. 安徽医药, 2018, 22(8): 1551-1552.
6.	Chan EW, Gannon SR, Shannon CN, et al. The impact of curve severity on obstetric complications and regional anesthesia utilization in pregnant patients with adolescent idiopathic scoliosis: a preliminary analysis. Neurosurg Focus, 2017, 43(4): E4.
7.	Falick-Michaeli T, Schroeder JE, Barzilay Y, et al. Adolescent idiopathic scoliosis and pregnancy: an unsolved paradigm. Global Spine J, 2015, 5(3): 179-184.
8.	Lin MC, Liaw MY, Chen WJ, et al. Pulmonary function and spinal characteristics: their relationships in persons with idiopathic and postpoliomyelitic scoliosis. Arch Phys Med Rehabil, 2001, 82(3): 335-341.
9.	王杨, 朱泽章, 邱勇, 等. 青少年特发性脊柱侧凸患者胸弯对心脏结构和功能的影响. 中国脊柱脊髓杂志, 2016, 26(8): 723-728.
10.	Hawkins JL, Chang J, Palmer SK, et al. Anesthesia-related maternal mortality in the United States: 1979-2002. Obstet Gynecol, 2011, 117(1): 69-74.
11.	Terblanche N, Maxwell C, Keunen J, et al. Obstetric and anesthetic management of severe congenital myasthenia syndrome. Anesth Analg, 2008, 107(4): 1313-1315.
12.	Chopra S, Adhikari K, Agarwal N, et al. Kyphoscoliosis complicating pregnancy: maternal and neonatal outcome. Arch Gynecol Obstet, 2011, 284(2): 295-297.
13.	Ko JY, Leffert LR. Clinical implications of neuraxial anesthesia in the parturient with scoliosis. Anesth Analg, 2009, 109(6): 1930-1934.
14.	Gupta SL, Satya Prakash MV, et al. Use of i-gel for caesarean section with kyphoscoliosis. BMJ Case Rep, 2014, 2014: bcr2014203987.
15.	Wollowick AL, Farrelly EE, Meyers K, et al. Anterior release generates more thoracic rotation than posterior osteotomy: a biomechanical study of human cadaver spines. Spine (Phila Pa 1976), 2013, 38(18): 1540-1545.
16.	Zhu F, Zhang Y, Wang G, et al. PPosterior multisegment apical convex plus concave intervertebral release combined with posterior column osteotomy for the treatment of rigid thoracic/thoracolumbar scoliosis. World Neurosurg, 2023, 170: 43-53.
17.	Okutomi T, Saito M, Koura M, et al. Spinal anesthesia using a continuous spinal catheter for cesarean section in a parturient with prior surgical correction of scoliosis. J Anesth, 2006, 20(3): 223-226.
18.	Veliath DG, Sharma R, Ranjan R, et al. Parturient with kyphoscoliosis (operated) for cesarean section. J Anaesthesiol Clin Pharmacol, 2012, 28(1): 124-126.
19.	Feldstein G, Ramanathan S. Obstetrical lumbar epidural anesthesia in patients with previous posterior spinal fusion for kyphoscoliosis. Anesth Analg, 1985, 64(1): 83-85.
20.	Dolak JA, Tartt S. Spinal anesthesia for cesarean delivery in a parturient with spondylocostal dysostosis. Can J Anaesth, 2009, 56(2): 172-173.
21.	Hilton G, Mihm F, Butwick A. Anesthetic management of a parturient with vacterl association undergoing cesarean delivery. Can J Anaesth, 2013, 60(6): 570-576.
22.	Snoeck M, van Engelen BG, Küsters B, et al. RYR1-related myopathies: a wide spectrum of phenotypes throughout life. Eur J Neurol, 2015, 22(7): 1094-1112.
23.	Klein A, Lillis S, Munteanu I, et al. Clinical and genetic findings in a large cohort of patients with ryanodine receptor 1 gene-associated myopathies. Hum Mutat, 2012, 33(6): 981-988.
24.	Rosenberg H, Sambuughin N, Riazi S, et al. Malignant hyperthermia susceptibility. Seattle: University of Washington, 2003.
25.	Barker A. Caesarean section under local analgesia. Lancet, 1971, 1(7688): 40.
26.	刘梦雪, 刘霞, 许婷. 妊娠合并重度脊柱侧弯行超声引导下硬膜外麻醉一例. 临床麻醉学杂志, 2021, 37(2): 219-220.

1. Negrini S, Donzelli S, Aulisa AG, et al. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord, 2018, 13: 3.
2. Sharma S, Gao X, Londono D, et al. Genome-wide association studies of adolescent idiopathic scoliosis suggest candidate susceptibility genes. Hum Mol Genet, 2011, 20(7): 1456-1466.
3. Weinstein SL, Dolan LA, Cheng JC, et al. Adolescent idiopathic scoliosis. Lancet, 2008, 371(9623): 1527-1537.
4. 李雄飞, 陈秀丽, 邵杰, 等. 青少年特发性脊柱侧凸女性患者治疗后生育状况及评估方法研究进展. 海军军医大学学报, 2022, 43(5): 546-549.
5. 彭影, 彭程, 吴大保. 妊娠合并重度脊柱侧凸畸形 6 例分析. 安徽医药, 2018, 22(8): 1551-1552.
6. Chan EW, Gannon SR, Shannon CN, et al. The impact of curve severity on obstetric complications and regional anesthesia utilization in pregnant patients with adolescent idiopathic scoliosis: a preliminary analysis. Neurosurg Focus, 2017, 43(4): E4.
7. Falick-Michaeli T, Schroeder JE, Barzilay Y, et al. Adolescent idiopathic scoliosis and pregnancy: an unsolved paradigm. Global Spine J, 2015, 5(3): 179-184.
8. Lin MC, Liaw MY, Chen WJ, et al. Pulmonary function and spinal characteristics: their relationships in persons with idiopathic and postpoliomyelitic scoliosis. Arch Phys Med Rehabil, 2001, 82(3): 335-341.
9. 王杨, 朱泽章, 邱勇, 等. 青少年特发性脊柱侧凸患者胸弯对心脏结构和功能的影响. 中国脊柱脊髓杂志, 2016, 26(8): 723-728.
10. Hawkins JL, Chang J, Palmer SK, et al. Anesthesia-related maternal mortality in the United States: 1979-2002. Obstet Gynecol, 2011, 117(1): 69-74.
11. Terblanche N, Maxwell C, Keunen J, et al. Obstetric and anesthetic management of severe congenital myasthenia syndrome. Anesth Analg, 2008, 107(4): 1313-1315.
12. Chopra S, Adhikari K, Agarwal N, et al. Kyphoscoliosis complicating pregnancy: maternal and neonatal outcome. Arch Gynecol Obstet, 2011, 284(2): 295-297.
13. Ko JY, Leffert LR. Clinical implications of neuraxial anesthesia in the parturient with scoliosis. Anesth Analg, 2009, 109(6): 1930-1934.
14. Gupta SL, Satya Prakash MV, et al. Use of i-gel for caesarean section with kyphoscoliosis. BMJ Case Rep, 2014, 2014: bcr2014203987.
15. Wollowick AL, Farrelly EE, Meyers K, et al. Anterior release generates more thoracic rotation than posterior osteotomy: a biomechanical study of human cadaver spines. Spine (Phila Pa 1976), 2013, 38(18): 1540-1545.
16. Zhu F, Zhang Y, Wang G, et al. PPosterior multisegment apical convex plus concave intervertebral release combined with posterior column osteotomy for the treatment of rigid thoracic/thoracolumbar scoliosis. World Neurosurg, 2023, 170: 43-53.
17. Okutomi T, Saito M, Koura M, et al. Spinal anesthesia using a continuous spinal catheter for cesarean section in a parturient with prior surgical correction of scoliosis. J Anesth, 2006, 20(3): 223-226.
18. Veliath DG, Sharma R, Ranjan R, et al. Parturient with kyphoscoliosis (operated) for cesarean section. J Anaesthesiol Clin Pharmacol, 2012, 28(1): 124-126.
19. Feldstein G, Ramanathan S. Obstetrical lumbar epidural anesthesia in patients with previous posterior spinal fusion for kyphoscoliosis. Anesth Analg, 1985, 64(1): 83-85.
20. Dolak JA, Tartt S. Spinal anesthesia for cesarean delivery in a parturient with spondylocostal dysostosis. Can J Anaesth, 2009, 56(2): 172-173.
21. Hilton G, Mihm F, Butwick A. Anesthetic management of a parturient with vacterl association undergoing cesarean delivery. Can J Anaesth, 2013, 60(6): 570-576.
22. Snoeck M, van Engelen BG, Küsters B, et al. RYR1-related myopathies: a wide spectrum of phenotypes throughout life. Eur J Neurol, 2015, 22(7): 1094-1112.
23. Klein A, Lillis S, Munteanu I, et al. Clinical and genetic findings in a large cohort of patients with ryanodine receptor 1 gene-associated myopathies. Hum Mutat, 2012, 33(6): 981-988.
24. Rosenberg H, Sambuughin N, Riazi S, et al. Malignant hyperthermia susceptibility. Seattle: University of Washington, 2003.
25. Barker A. Caesarean section under local analgesia. Lancet, 1971, 1(7688): 40.
26. 刘梦雪, 刘霞, 许婷. 妊娠合并重度脊柱侧弯行超声引导下硬膜外麻醉一例. 临床麻醉学杂志, 2021, 37(2): 219-220.

West China Medical Journal

Anesthesia management of pregnancy with moderate to severe scoliosis

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