Getting Pregnant After Pro-Disc

Now there’s a question. “Doctor, after my surgery will I be able to have a baby and carry it to term safely—for both me and my child?”

The basic premise of motion preserving implants in the spine is that they will preserve motion. But did the designers of the Pro-Disc have pregnancy in mind? Or hours of labor in the delivery room? Or even, as it possibly turns out, a passionate moment in the hospital room?

During pregnancy the mother-to-be is not only eating for two people, she’s also carrying the load for two people. Not surprisingly, half the pregnant women experience back pain and a third have severe back pain.

But what happens if the mom-to-be has had spine surgery and had a motion preserving spinal device implanted?

That was the interesting question posed by Jack Zigler, M.D., and his team at the Texas Back Institute in Plano, Texas. The physicians at Texas Back were part of several ground breaking clinical studies of motion preserving spinal implants and have one of the largest registries of patients with motion preserving implants.

So Drs. Owusu, Hsu and Zigler mined the Texas Back database for former motion preservation implant patients of child bearing age. They found 18 women who not only met the criteria…but had given birth after their spine surgery.

Including one woman who gave birth nine months after her surgery.

Pregnancy and Back Pain

Pregnancy is the leading cause of back pain for women. According to the Centers for Disease Control (CDC), there are more than 3.9 million births in the U.S. annually. Using data from the literature: that would imply more than 2 million cases of back pain and 1 million cases of severe back pain among pregnant women.

In one study (Prevalence and factors associated with low back pain and pelvic girdle pain during pregnancy: a multicenter study conducted in the Spanish National Health Service. Kovacs FM¹, Garcia E, Royuela A, González L, Abraira V; Spanish Back Pain Research Network) published in Spine (August 1, 2012), researchers gathered data from 61 clinicians and 1, 158 pregnant women regarding their levels of back, leg and pelvic pain.

The results showed that the four-week prevalence of low back pain and leg pain for the women was 71.3% and 46.2%, respectively.

What factors were associated with back pain and pregnancy—aside from the fact that there is a baby growing in the womb? They were:

• A history of low back pain
• Lower academic level
• Younger age
• Depression
• Lower number of hours slept per night
• Higher BMI (body mass index)

But one factor which did NOT correlate with high rates of back pain was a history of spine surgery. In fact, previous lumbar surgery was associated with a lower risk of pregnancy induced back pain.

But young female patients will want to know. Can I get pregnant or will the increased load on my spine create problems for me, my new motion preserving disc or my baby?

The Texas Back Pregnancy Study

The Texas Back research group identified 18 patients who had become pregnant sometime after their lumbar TDR (total disc replacement) surgery. The researchers collected information from the patient’s clinic records and then mailed questionnaires to each woman. Sixteen of the 18 women responded, although not all patients responded to all questions.

Results

The average age of these women was 28.2 years. A description of the patients and results are provided in the table at the end of this article. The average patient age at the time of surgery was 28.2 years. Most of the patients (77.8%) had a single level operation with L5-S1 being the most common level.

Delivery and Birth Weight

None of the former patients had any pregnancy-related complications. The average length of time from surgery to delivery was a little more than three years (38.7 months) with, as noted above, one patient who gave birth nine months after her spine surgery.

Of the 16 patients who answered their Texas Back questionnaires, 10 (62.5%) had caesarian sections while 6 (37.5%) had vaginal delivery. Fourteen of 16 patients carried to term, the remaining two delivered twins prematurely. The average birth weight was 7.4 pounds with the exception of the twins who had a mean weight of 4.4 pounds (range: 3.9 to 4.9 pounds).

In other words, excellent birth weights.

And, How About Twins or Second Pregnancies?

Three patients in the study went on to have a second pregnancy post-TDR and all carried to full term. A. One had a cesarean section, and the other two had vaginal deliveries. One of the three had increased back pain during pregnancy which resolved after delivery.

And, two of the patients had twins!

Conclusions — According to the Texas Back team, here are the takeaways from this study:

“Although based on a relatively small patient sample, pregnancy after lumbar TDR surgery followed a typical course with no spine related complications. The percentage of women delivering via caesarian section 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 become pregnant after TDR surgery that they should not be unduly concern about the safety of pregnancy and delivery due to their spine surgery.”

Table: Study Population and Pregnancy Information