Childbearing, Sexual Function and Limitations - Effect on Curve Size? Patients with Adolescent Idiopathic Scoliosis Twenty Two Years After Treatment. Comparison with a Matching Control Group of Straight Individuals

Aina J Danielsson MD,
Alf L Nachemson MD, PhD
Sahlgrenska University Hospital, Göteborg, Sweden

INTRODUCTION:
A consecutive series of patients with adolescent idiopathic scoliosis, treated between 1968 and 1977, either with distraction and fusion using Harrington rods (ST, n=156) or with brace (BT, n=127) were followed at least twenty years after completion of the treatment.

PURPOSE:
To determine the long–term outcome with regard to childbearing, sexual function and curve progression.

METHODS:
One hundred and thirty–six (94%) of female ST and 111 (91%) of female BT patients filled in a questionnaire concerning childbearing and sexual life, as part of an unbiased personal f.u. examination. Of those, 129 ST and 105 BT patients had a radiographic examination. Curve size (Cobb method) was measured on present and earlier examinations. An age matched control group of 90 females was randomly selected and subjected to the same examinations.

RESULTS:
The mean age was 39.7 for ST, 39.3 for BT group and 39.1 years for the controls. 85% of ST and BT patients and 82% of controls were, or had been, married. There was a total of 628 pregnancies and no significant difference of number of children born (mean values ST 1.8, BT 1.9 and controls 2.0) between the groups. Patients in the BT group had a significantly higher age at first pregnancy (28.0 versus 26.6 in ST and 25.9 years in controls) and higher frequency of low back pain during pregnancy than ST group and controls. The rate of ceasarean sections were equal between the groups (10–14%, ns). Using two different questionnaires, we received different answers with regard to sexual function; with MODEM'S 10% of ST, 6% of BT and 4% of controls found that their sexual function was limited by back pain, but according to Oswestry Low Back Pain Disability Questionnaire this occcurred in 7, 6 an 1% respectively. Even within MODEM's the different questions on limitation in sexual activity revealed different answers; 2% of ST, 13% of BT patients and 7% of controls had any limitation. Scoliosis patients were limited mostly because of difficulties to physically participate in activities or self–consciousness about appearance. Pain was a minor reason for limitation in both questionnaires. There were no significant difference in curve progress with regard to age at first pregnancy or the number of pregnancies.

CONCLUSION:
Patients treated for adolescent idiopathic scoliosis seems to function well with regard to marital status and number of children. The scoliotic curve did not increase due to effects of childbearing. There are minor problems during pregnancy and delivery. Sexual life is affected in some patients.