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.