Women who have had spinal fusion surgery face some extra questions when pregnant: Can I give birth vaginally? Can I have an epidural? Will I experience more pregnancy back pain? There are some popular misconceptions surrounding these questions, and clearing them up will help you to better understand your situation.
Spinal fusion surgery is often performed to prevent progressive scoliosis curvature or to limit painful motion of a spinal segment caused by a herniated disc or vertebral slip. The procedure usually involves the use bone grafts that fuse spinal segments together and hardware that helps limit motion and promote fusion. Women are often concerned that a fusion in the lumbar and sacral spine regions may interfere with pregnancy and delivery.
Some women are concerned that limited flexibility and hardware implantation in the lower back will predestine them for Cesarian birth. This, however, is not the case. Most women with spinal fusions can give birth naturally. According to one small study, found at www.ncbi.nlm.nih.gov, women who had spinal surgery had the same rate of C-section delivery as women who hadn’t had surgery (about 1 out of 3).
Of course, every pregnancy is different and the specifics of your situation may promote a C-section. If you became pregnant shortly after your surgery, for example, a natural delivery may put too much stress on your unhealed back. It can take about a year for a single level fusion to set up, and 2 years for a full-spine fusion typical for scoliosis patients. If you become pregnant within a year or two of surgery, the fusion may not be solid and the surgery may fail. This may happen simply due to the extra stress placed on the spine by weight gain during pregnancy as well. To avoid further damage, a C-section may be ordered.
Whether or not to have an epidural after spinal fusion surgery is a decision based on many variables; the condition of your fusion, the comfort level of your anesthesiologist and personal preference all factor in.
Your spinal column houses a bundle of nerves that transport signals from the brain to all parts of the body and back. This nerve bundle is called the spinal cord. Between the vertebrae of the spine and the spinal cord sit the dural sac and the epidural space. The dural sac surrounds the spinal cord. The epidural space, consisting of fat and blood vessels, surrounds the dural sac.
During an epidural procedure, an injection bathes the spinal cord in a steroid that reduces inflammation and an anesthetic that helps to reduce pain . A needle pierces the epidural space, and a catheter is slipped through to allow the steroid to flow into the area. The epidural space is more difficult to get to when vertebrae are fused together. It is not impossible, however, to find the space; an experienced anesthesiologist, equipped with X-rays of your spine, may be able to navigate the needle to the space. Some may choose not to perform this type of anesthesia due to the risk of infecting fusion hardware or missing the right spot. Alternatives to epidural injections are IV medication and spinal block injection.
More Back Pain?
Back pain is very common during pregnancy, particularly during the last trimester and labor. Having a fused spine doesn’t necessarily predispose you to more back pain; however, having a fusion that is not thoroughly set up does. If you became pregnant before recovering from surgery, you will likely experience the pain caused by segment instability or scoliosis curvature that you had before the surgery combined with the pains commonly associated with pregnancy. You may require re-operation of the spine after recovering from delivery.
Pregnancy after spinal fusion comes with a lot of questions for women. Talk with your doctor and anesthesiologist about all of your questions and concerns to come to the best plan for your particular needs.