Pregnancy after Lumbar Total Disc Replacement

Abstract

Introduction There is much literature addressing back pain and pregnancy, often attributing the pain to changing loads and stresses on the spine. There is much less information available on pregnancy after lumbar spinal surgery. Many women considering surgery or who have undergone surgery are of child-bearing age. They may have concerns about the safety of pregnancy after surgery. This may be particularly true of procedures performed through an anterior approach, such as lumbar total disc replacement (TDR). The purpose of this study was to evaluate the course of back pain and safety of pregnancy after lumbar TDR. Patients and Methods From a single center, 18 patients were identified who became pregnant after lumbar TDR surgery. Data were recorded from clinic records and mailed questionnaires. Questionnaire data were collected for 15 of 18 patients, although not all patients responded to all questions. For the remaining three patients, as much data as possible were collected from charts. The mean patient age at the time of surgery was 28.2 years, ranging from 25 to 35 years. The majority of patients (77.8%) had a single level operation with L5–S1 being the most common. Results Information related to back pain during pregnancy was available for 16 patients. Eight (50%) reported no increase in back pain during pregnancy, while the remaining eight did report increased back pain. Among the eight patients with increased back pain, it resolved postdelivery in all but one. There were no pregnancy-related complications. The mean time from surgery to delivery was 38.7 months (range, 9–102 months). Of the 15 patients for whom delivery method information was available, 10 (66.7%) had caesarian delivery while 5 (33.3%) had vaginal delivery. Of the 15 patients, 13 carried to term. The remaining two patients delivered twins prematurely. The mean birth weight was 7.4 pounds with the exception of the two sets of twins who had a mean weight of 4.4 pounds (range, 3.9–4.9 pounds). Three patients experienced two pregnancies post-TDR. Data for the first pregnancy are included earlier. In all the three patients, the second pregnancy was carried to term; one had a cesarean delivery, and the other two had vaginal delivery. One of the three had increased back pain during pregnancy which resolved after delivery. Conclusion Although based on a small patient sample, this study found that pregnancy after lumbar TDR surgery followed a typical course with no spine-related complications. The percentage of women delivering via cesarean delivery was greater than the 32.8% reported in the Center for Disease Control and Prevention's National Center for Health Statistics for 2012. It is hoped that this study may provide reassurance to women who were pregnant after TDR surgery that they should not be unduly concern about the safety of pregnancy and delivery because of their spine surgery.