Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-7479d7b7d-fwgfc Total loading time: 0 Render date: 2024-07-12T02:30:50.691Z Has data issue: false hasContentIssue false

7 - Disorders of the vertebral column

from Section 2 - Musculoskeletal disorders

Published online by Cambridge University Press:  19 October 2009

By
Edward T. Crosby
Edited by
David R. Gambling ,
M. Joanne Douglas  and
Robert S. F. McKay
Edward T. Crosby
Affiliation:
Department of Anesthesiology, Ottawa Hospital – General Campus, Ottawa, Ontario, Canada
David R. Gambling
Affiliation:
University of California, San Diego
M. Joanne Douglas
Affiliation:
University of British Columbia, Vancouver
Robert S. F. McKay
Affiliation:
University of Kansas
Get access

Summary

Introduction

Symptoms relating to the musculoskeletal system are among the most common complaints registered by pregnant women. The maternal axial skeleton is subjected to considerable gestational changes and stresses and skeletal anomalies, both congenital and acquired, may impact on the process and outcome of gestation and labor. Among the most important of these anomalies is scoliosis, arising either as the idiopathic form or as a result of an underlying neuromuscular disorder.

Other syndromes are less commonly encountered: these include disc prolapse, osteoporosis of pregnancy, and spondylolysis and spondylolisthesis.

Scoliosis

Moderate to severe scoliotic curves are not common in women of childbearing age. The major reason for this is that screening programs identify many at-risk women early in the disease process, resulting in timely intervention and curve correction. Additionally, primary neuromuscular diseases that result in scoliosis are relatively rare and may themselves limit a woman's reproductive potential. Despite the fact that women with moderate to severe scoliosis constitute a small population of obstetric patients, pregnancy within this population is common. The process and outcome of pregnancy, labor, and delivery are often similar in women with scoliosis compared with the general population. However, if the disease process is advanced, pregnancy and labor may not only be complicated, but also life-threatening. In this small subpopulation, a detailed understanding of the pathophysiology of advanced scoliosis and the interaction with pregnancy is necessary to provide effective maternal care.

Type
Chapter
Information
Obstetric Anesthesia and Uncommon Disorders , pp. 129 - 144
Publisher: Cambridge University Press
Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Goldstein, L. A. & Waugh, T. R.Classification and terminology of scoliosis. Clin. Orthop. 1973; 93: 10–22.Google Scholar
Winter, R. B.Posterior spinal fusion in scoliosis: indication, technique and results. Orthop. Clin. North Am. 1979; 10: 787–800.Google Scholar
Kafer, E. R.Respiratory and cardiovascular functions in scoliosis and the principles of anesthetic management. Anesthesiology 1980; 52: 339–51.Google Scholar
Kopenhager, T.A review of 50 pregnant patients with kyphoscoliosis. Br. J. Obstet. Gynaecol. 1977; 84: 585–7.Google Scholar
Sarikaya, S., Özdolap, S. & Açikgöz, G.Pregnancy-associated osteoporosis with vertebral fractures and scoliosis. Jt. Bone Spine 2004; 71: 84–5.Google Scholar
Shands, A. R. & Eisberg, H. B.The incidence of scoliosis in the state of Delaware. J. Bone Joint Surg. 1955; 37A: 1243.Google Scholar
Bergofsky, E. H.Respiratory failure in disorders of the thoracic cage. Am. Rev. Resp. Dis. 1979; 119: 643–9.Google Scholar
Chow, D.Scoliosis: A surgical perspective. Prob. Anesth. 1991; 5: 40–51.Google Scholar
Winter, R B.Adolescent idiopathic scoliosis. N. Engl. J. Med. 1986; 314: 1379–80.Google Scholar
Carter, C. D. & Haynes, S. G.Prevalence rates for scoliosis in US adults: results from the first National Health and Nutrition Examination Survey. Int. J. Epidemiol. 1987; 16: 537–44.Google Scholar
Torell, G., Nordwall, A. & Nachemson, A.The changing pattern of scoliosis treatment due to screening. J. Bone Joint Surg. 1981; 63A: 337–41.Google Scholar
Visscher, W., Lonstein, J. E., Hoffman, D. A.et al. Reproductive outcomes in scoliosis patients. Spine 1988; 13: 1096–8.Google Scholar
Danielsson, A. J. & Nachemson, A. L.Childbearing, curve progression, and sexual function in women 22 years after treatment for adolescent idiopathic scoliosis. A case-controlled study. Spine 2001; 26: 1449–56.Google Scholar
Orvomaa, E., Hiilesmaa, V., Poussa, M., Snellman, O. & Tallroth, K.Pregnancy and delivery in patients operated by the Harrington method for idiopathic scoliosis. Eur. Spine J. 1997; 6: 304–7.Google Scholar
To, W. W. K. & Wong, M. W. N.Kyphoscoliosis complicating pregnancy. Int. J. Gynecol. Obstet. 1996; 55: 123–8.Google Scholar
Lonstein, J. E. & Carlson, J. M.The prediction of curve progression in untreated idiopathic scoliosis during growth. J. Bone Joint Surg. 1984; 66A: 1061–71.Google Scholar
Pehrsson, K., Larsson, S., Oden, A. & Nachemson, A.Long-term follow-up of patients with untreated scoliosis. A study of mortality, causes of death, and symptoms. Spine 1992; 17: 1091–6.Google Scholar
Collis, D. K. & Ponseti, I. V.Long-term follow-up patients with idiopathic scoliosis not treated surgically. J. Bone Joint Surg. 1969; 51A: 425–45.Google Scholar
Freychuss, U., Nilsonne, U. & Lundgren, K. D.Idiopathic scoliosis in old age. I. Respiratory function. Acta. Med. Scand. 1968; 184: 365–72.Google Scholar
Sevastik, J. A., Aaro, S. & Normelli, H.Scoliosis: experimental and clinical studies. Clin. Orthop. 1984; 191: 27–34.Google Scholar
White, A. A., 3rd & Panjabi, M. M. Practical biomechanics of scoliosis and kyphosis. In Clinical Biomechanics of the Spine, 2nd ed. Philadelphia: J B Lippincott, 1990.
Gazioglu, K., Goldstein, L. A., Femi-Pearse, D.et al. Pulmonary function in idiopathic scoliosis. Comparative evaluation before and after orthopaedic correction. J. Bone Joint Surg. 1968; 50A: 1391–8.Google Scholar
Lindh, M. & Bjure, J.Lung volumes in scoliosis before and after correction by the Harrington instrumentation method. Acta. Orthop. Scand. 1975; 46: 934–48.Google Scholar
Zorab, P. A., Prime, F. J. & Harrison, A.Lung function in young persons after spine fusion for scoliosis. Spine 1979; 4: 22–8.Google Scholar
Kumano, K. & Tsoyoma, N.Pulmonary function before and after surgical correction with scoliosis. J. Bone Joint Surg. 1982; 64A: 242–8.Google Scholar
Ogilvie, J. W. & Schendel, M. J.Calculated thoracic volume as related to parameters of scoliosis correction. Spine 1988; 13: 39–42.Google Scholar
Sponseller, P. D., Cohen, M. S., Nachemson, A. L.et al. Results of surgical treatment of adults with idiopathic scoliosis. J. Bone Joint Surg. 1987; 69A: 667–75.Google Scholar
Cochran, T., Irstam, L. & Nachemson, A.Long-term anatomic and functional changes in patients with adolescent idiopathic scoliosis treated by Harrington rod fusion. Spine 1983; 8: 576–84.Google Scholar
Moskowitz, A., Moe, J. H., Winter, R. B. & Binner, H.Long-term followup of scoliosis fusion. J. Bone Joint Surg. 1980; 62A: 364–9.Google Scholar
Hamilton, P. P. & Byford, L. J.Respiratory pathophysiology in musculoskeletal disorders. Prob. Anesth. 1991; 5: 91–106.Google Scholar
Roussos, C. S. & Macklem, P. T.Diaphragmatic fatigue in man. J. Appl. Physiol. 1977; 43: 189–97.Google Scholar
Kesten, S., Garfinkel, S. K., Wright, T.et al. Impaired exercise capacity in adults with moderate scoliosis. Chest 1991; 99: 663–6.Google Scholar
Mezon, B. L., West, P., Israels, J.et al. Sleep breathing abnormalities in scoliosis. Am. Rev. Respir. Dis. 1980; 122: 617–21.Google Scholar
Roth, A., Rosenthal, A., Hall, J. E.et al. Scoliosis and congenital heart disease. Clin. Orthop. 1973; 93: 95–102.Google Scholar
Hirschfeld, S. S., Rudner, C., Nasch, C. L.et al. The incidence of mitral valve prolapse in adolescent scoliosis and thoracic hypokyphosis. Pediatrics 1982; 70: 451–4.Google Scholar
Weitzenblum, E.Chronic cor pulmonale. Heart 2003; 89: 225–30.Google Scholar
Spinnato, J. A., Kraynack, B. J. & Cooper, M. W.Eisenmenger's syndrome in pregnancy: epidural anesthesia for elective cesarean section. N. Engl. J. Med. 1981; 304: 1215–17.Google Scholar
Warnes, C. A.Pregnancy and pulmonary hypertension. Int. J. Cardiol. 2004; 97: 11–13.Google Scholar
Weiss, B. M., Zemp, L., Seifert, B.et al. Outcome of pulmonary vascular disease in pregnancy: a systematic overview from 1978 through 1996. J. Am. Col. Cardiol. 1998; 31: 1650–7.Google Scholar
Rich, S.Primary pulmonary hypertension. Prog. Cardiovasc. Dis. 1998; 31: 205–9.Google Scholar
Gummerus, M. & Laasonen, H.Eisenmenger complex and pregnancy. Ann. Chir. Gynaecol. 1981; 70: 339–41.Google Scholar
Sullivan, P. J., Miller, D. R. & Wynands, J. E.Cardiovascular manifestations of musculoskeletal diseases. Prob. Anesth. 1991; 5: 107–23.Google Scholar
Yim, R., Kirschner, K., Murphy, E., Parson, J. & Winslow, C.Successful pregnancy in a patient with spinal muscular atrophy and severe kyphoscoliosis. Am. J. Phys. Med. Rehabil. 2003; 82: 222–5.Google Scholar
Weston, L. A. & DiFazio, C. A.Labor analgesia and anesthesia in a patient with spinal muscular atrophy and vocal cord paralysis. Reg. Anesth. 1996; 21: 350–4.Google Scholar
Berman, A. T., Cohen, D. L. & Schwentker, E. P.The effects of pregnancy on idiopathic scoliosis. A preliminary report on eight cases and a review of the literature. Spine 1982; 7: 76–7.Google Scholar
Blount, W. P. & Mellencamp, D. D.The effect of pregnancy on idiopathic scoliosis. J. Bone Joint Surg. 1980; 62A: 1083–7.Google Scholar
Betz, R. R., Bunnell, W. P., Lambrecht-Mulier, E. & MacEwan, G. D.Scoliosis and pregnancy. J. Bone Joint Surg. 1987; 69A: 90–6.Google Scholar
Sawicka, E. H., Spencer, G. T. & Branthwaite, M. A.Management of respiratory failure complicating pregnancy in severe kyphoscoliosis: a new use for an old technique?Br. J. Dis. Chest 1986; 80: 191–6.Google Scholar
Siegler, D. & Zorab, P. A.Pregnancy in thoracic scoliosis. Br. J. Dis. Chest 1981; 75: 367–70.Google Scholar
Manning, C. W., Prime, F. J. & Zorab, P. A.Pregnancy and scoliosis. Lancet 1967; 2: 792–5.Google Scholar
Zeldis, S. M.Dyspnea during pregnancy. Distinguishing cardiac from pulmonary causes. Clin. Chest Med. 1992; 13: 567–85.Google Scholar
Gilbert, R. & Auchincloss, J.Dyspnea of pregnancy: clinical and physiological observations. Am. J. Med. Sci. 1966; 252: 270–6.Google Scholar
Nava, S., Zanotti, E., Ambrosino, N.et al. Evidence of acute diaphragmatic fatigue in a “natural” condition. Am. Rev. Respir. Dis. 1992; 146: 1226–30.Google Scholar
Charbonneau, M., Falcone, T., Cosio, M. G.et al. Obstructive sleep apnea during pregnancy: therapy and implications for fetal health. Am. Rev. Respir. Dis. 1991; 144: 461–3.Google Scholar
Schneerson, J. M.Pregnancy in neuromuscular and skeletal disorders. Monaldi Arch. Chest Dis. 1994; 49: 227–30.Google Scholar
Report on Confidential Enquiries into Maternal Deaths in the United Kingdom 1985–87. London: Her Majesty's Stationery Office, 1991.
Report on Confidential Enquiries into Maternal Deaths in the United Kingdom 1988–90. London: Her Majesty's Stationery Office, 1994.
Gandevia, S. C.Muscle fatigue. Does the diaphragm fatigue during parturition?Lancet 1993; 341: 347–8.Google Scholar
Jones, D. H.Kyphoscoliosis complicating pregnancy. Lancet 1964; 1: 517–19.Google Scholar
Phelan, J. P., Dainer, M. I. & Cowherd, D. W.Pregnancy complicated by thoracolumbar scoliosis. South Med. J. 1978; 71: 76–8.Google Scholar
Crosby, E. T. & Halpern, S. H.Obstetric epidural anaesthesia in patients with Harrington instrumentation. Can. J. Anaesth. 1989; 36: 693–6.Google Scholar
Smedstead, K. G., Cramb, R. & Morison, D. H.Pulmonary hypertension and pregnancy: a series of eight cases. Can. J. Anaesth. 1994; 41: 502–12.Google Scholar
Roberts, N. V. & Keast, P. J.Pulmonary hypertension and pregnancy – a lethal combination. Anaesth. Intens. Care 1990; 18: 366–74.Google Scholar
Weeks, S. K. & Smith, J. B.Obstetric anaesthesia in patients with primary pulmonary hypertension. Can. J. Anaesth. 1991; 38: 814–16.Google Scholar
Daley, M. D., Morningstar, B. A., Rolbin, S. H.et al. Epidural anesthesia for obstetrics after spinal surgery. Reg. Anesth. 1990; 15: 280–4.Google Scholar
Bach, J. R.Successful pregnancies for ventilator users. Am. J. Phys. Med. Rehabil. 2003; 82: 226–9.Google Scholar
Restrick, L. J., Clapp, B. R., Mikelsons, C.et al. Nasal ventilation in pregnancy: treatment of nocturnal hypoventilation in a patient with kyphoscoliosis. Eur. Respir. J. 1997; 10: 2657–8.Google Scholar
Chau, W. & Lee, K. H.Kyphosis complicating pregnancy. J. Obstet. Gynaecol. Br. Common. 1970; 77: 1098–102.Google Scholar
Bader, A. M. Neurologic and neuromuscular disease. In Chestnut, D. H. (ed.), Obstetric Anesthesia: Principles and Practice, 3rd edn. Philadelphia, PA: Elsevier Mosby, 2004.
Harnett, M., Mushlin, P. S. & Camann, W. R. Cardiovascular disease. In Chestnut, D. H. (ed.), Obstetric Anesthesia: Principles and Practice, 3rd edn. Philadelphia, PA: Elsevier Mosby, 2004.
Martin, J. T., Tautz, T. J. & Antognini, J. F.Safety of regional anesthesia in Eisenmenger's syndrome. Reg. Anesth. 2002; 27: 503–13.Google Scholar
Feldstein, G. & Ramanathan, S.Obstetrical lumbar epidural anesthesia in patients with previous posterior spinal fusion for kyphoscoliosis. Anesth. Analg. 1985; 64: 83–5.Google Scholar
Hubbert, C. H.Epidural anesthesia in patients with spinal fusion. Anesth. Analg. 1985; 64: 843.Google Scholar
Aaro, S. & Ohlen, G.The effect of Harrington instrumentation on the sagittal mobility of the spine in scoliosis. Spine 1983; 8: 570–5.Google Scholar
Sponseller, P. D., Cohen, M. S., Nachemson, A. L.et al. Results of surgical treatment of adults with idiopathic scoliosis. J. Bone Joint Surg. 1987; 69A: 667–75.Google Scholar
LaRocca, H. & MacNab, I.The laminectomy membrane. Studies in its evolution, effects and prophylaxis in dogs. J. Bone Joint Surg. 1974; 56: 545–50.CrossRefGoogle Scholar
Chestnut, D. H., Owen, C. L., Bates, I. N.et al. Continuous infusion epidural analgesia during labor: a randomized, double-blind comparison of 0.0625% bupivacaine/0.0002% fentanyl versus 0.125% bupivacaine. Anesthesiology 1988; 68: 754–9.Google Scholar
Norris, M. C., Grieco, W. M., Borkowski, M.et al. Complications of labor analgesia: epidural versus combined spinal epidural techniques. Anesth. Analg. 1994; 79: 529–37.Google Scholar
Cohen, S. E., Cherry, S. M., Holbrook, R. H. Jr, et al. Intrathecal sufentanil for labor analgesia-sensory changes, side effects and fetal heart rate changes. Anesth. Analg. 1993; 77: 1155–60.Google Scholar
Ducey, J. P., Knape, K. G., Talbot, J.et al. Intrathecal narcotics for labor cause hypotension (abstract). Anesthesiology 1992; 77: A997.Google Scholar
Camann, W. R., Mintzer, B. H., Denney, R. A.et al. Intrathecal sufentanil for labor analgesia: effects of added epinephrine. Anesthesiology 1993; 78: 870–4.Google Scholar
Camann, W. R., Denney, R. A., Holby, E. D.et al. A comparison of intrathecal, epidural, and intravenous sufentanil for labor analgesia. Anesthesiology 1993; 77: 884–7.Google Scholar
Honet, J. E., Arkoosh, V. A., Norris, M. C.et al. Comparison among intrathecal fentanyl, meperidine and sufentanil for labor analgesia. Anesth. Analg. 1991; 75: 734–9.Google Scholar
D'Angelo, R., Anderson, M. T., Philip, J.et al. Intrathecal sufentanil compared to epidural bupivacaine for labor analgesia. Anesthesiology 1994; 80: 1209–15.Google Scholar
Nielson, P. E., Ericksonm, J. R., Abouleish, E. I.et al. Fetal heart rate changes after intrathecal sufentanil of epidural bupivacaine for labor analgesia: incidence and clinical significance. Anesth. Analg. 1996; 83: 742–6.Google Scholar
Norris, M. C.Intrathecal opioids and fetal bradycardia: is there a link?Int. J. Obstet. Anesth. 2000; 9: 264–9.Google Scholar
Velde, M., Vercauteren, M. & Vandermeersch, E.Fetal heart rate abnormalities after regional anesthesia for labor pain: the effect of intrathecal opioids. Reg. Anesth. 2001; 26: 257–62.Google Scholar
Ransom, D. M. & Leicht, C. H.Continuous spinal analgesia with sufentanil for labor and delivery in a parturient with severe pulmonary stenosis. Anesth. Analg. 1995; 80: 418–21.Google Scholar
Leicht, C. H., Evans, D. E. & Durkan, W. J.Intrathecal sufentanil for labor analgesia: results of a pilot study. Anesthesiology 1990; 73: A980.Google Scholar
Johnson, M. D., Hurley, R. J., Gilbertson, L. I. & Datta, S.Continuous microcatheter spinal anesthesia with subarachnoid meperidine for labor and delivery. Anesth. Analg. 1990; 70: 658–61.Google Scholar
Moran, D. H. & Johnson, M. D.Continuous spinal anesthesia with combined hyperbaric and isobaric bupivacaine in a patient with scoliosis. Anesth. Analg. 1990; 70: 445–7.Google Scholar
Crosby, E. & Read, D.Salvaging inadequate epidural anaesthetics: the chloroprocaine save. Can. J. Anaesth. 1991; 38: 136.Google Scholar
Beck, G. N. & Griffiths, A. G.Failed extradural anaesthesia for Caesarean section. Complication of subsequent spinal block. Anaesthesia 1992; 47: 690–2.Google Scholar
Mets, B., Broccoli, E. & Brown, A. R.Is spinal anesthesia after failed epidural anesthesia contraindicated for Cesarean section?Anesth. Analg. 1993; 77: 629–31.CrossRefGoogle Scholar
Stone, P. A., Thorburn, J. & Lamb, K. S. R.Complications of spinal anaesthesia following extradural block for Caesarean section. Br. J. Anaesth. 1989; 62: 335–7.CrossRefGoogle Scholar
Waters, J. R., Leivers, D. & Hullander, M.Response to spinal anesthesia after inadequate epidural anesthesia. Anesth. Analg. 1994; 78: 1033–4.Google Scholar
Pascoe, H. F., Jennings, G. S. & Marx, G. F.Successful spinal anesthesia after inadequate epidural block in a parturient with prior surgical correction of scoliosis. Reg. Anesth. 1993; 18: 191–2.Google Scholar
Duggan, A. B. & Katz, S. G.Combined spinal and epidural anesthesia for caesarean section in a parturient with severe primary pulmonary hypertension. Anaesth. Int. Care 2003; 31: 565–9.Google Scholar
Gandhimathi, K., Atkinson, S. & Gibson, F. M.Pulmonary hypertension complicating twin pregnancy: continuous spinal anaesthesia for caesarean section. Int. J. Obstet. Anesth. 2002; 11: 301–5.Google Scholar
Miller, K. A., Harkin, C. P. & Bailey, P. L.Postoperative tracheal extubation. Anesth. Analg. 1995; 80: 149–72.Google Scholar
Ali, J., Weisel, R. D., Layug, A. B.et al. Consequences of postoperative alterations in respiratory mechanics. Am. J. Surg. 1974; 128: 376–82.Google Scholar
Strandberg, A., Tokics, L., Brismar, B.et al. Atelectasis during anaesthesia and in the postoperative period. Acta. Anaesthesiol. Scand. 1986; 30: 154–8.Google Scholar
Gamsu, G., Singer, M. M., Vincent, H.et al. Postoperative impairment of mucous transport in the lung. Am. Rev. Respir. Dis. 1976; 114: 673–9.Google Scholar
Bickler, P. E., Dueck, R. & Prutow, R. J.Effects of barbiturate anesthesia on functional residual capacity and ribcage/ diaphragm contributions to ventilation. Anesthesiology 1987; 66: 147–52.Google Scholar
Hodgkinson, R., Husain, F. J., Hayashi, H. & Hayashi, R.Systemic and pulmonary blood pressure during Caesarean section in parturients with gestational hypertension. Can. Anaesth. Soc. J. 1980; 27: 389–94.Google Scholar
Prewitt, R. M. & Ghignone, M.Treatment of right ventricular dysfunction in acute respiratory failure. Crit. Care Med. 1983; 11: 346–52.CrossRefGoogle Scholar
Mebazaa, A., Karpati, P., Renaud, E. & Algotsson, L.Acute right ventricular failure – from pathophysiology to new treatments. Intens. Care Med. 2004; 30: 185–96.CrossRefGoogle Scholar
Robinson, J. N., Bannerjee, R., Landzberg, M. J.et al. Inhaled nitric oxide therapy in pregnancy complicated by pulmonary hypertension. Am. J. Obstet. Gynecol. 1999; 180: 1045–6.Google Scholar
Steart, R., Tuazon, D., Olson, G.et al. Pregnancy and primary pulmonary hypertension: successful outcome with epoprostenol therapy. Chest 2001; 119: 973–5.Google Scholar
MacEvilly, M. & Buggy, D.Back pain and pregnancy: a review. Pain 1996; 64: 405–14.Google Scholar
Weinreb, J. C., Wolbarsht, L. B., Cohen, J. M., Brown, C. E. & Maravilla, K. R.Prevalence of lumbosacral intervertebral disc abnormalities on MR images in pregnant and asymptomatic pregnant women. Radiology 1989; 170: 125–8.Google Scholar
LaBan, M. M., Perrin, J. C. S. & Latimer, F. R.Pregnancy and the herniated lumbar disc. Arch. Phys. Med. Rehabil. 1983; 64: 319–21.Google Scholar
Garmel, S. H., Guzelian, G. A., D'Alton, J. G. & D'Alton, M. E.Lumbar disc disease in pregnancy. Obstet. Gynecol. 1997; 89: 821–2.Google Scholar
Brown, M. D. & Levi, A. D. O.Surgery for lumbar disc herniation during pregnancy. Spine 2001; 26: 440–3.Google Scholar
LaBan, M. M., Rapp, N. S., Oeyen, P.et al. The lumbar herniated disc of pregnancy: a report of six cases identified by magnetic resonance imaging. Arch. Phys. Med. Rehabil. 1995; 76: 476–9.Google Scholar
Ireland, M. L. & Ott, S. M.The effects of pregnancy on the musculoskeletal system. Clin. Orthopaed. Relat. Res. 2000; 372: 169–79.Google Scholar
Kohlmeier, L. & Marcus, R.Calcium disorders of pregnancy. Endocrinol. Metab. Clin. North Am. 1995; 24: 15–39.Google Scholar
Lin, J. T. & Lutz, G. E.Postpartum sacral fracture presenting as lumbar radiculopathy: a case report. Arch. Phys. Med. Rehabil. 2004; 85: 1358–61.Google Scholar
Sanderson, P. L. & Fraser, R. D.The influence of pregnancy on the development of degenerative spondylolisthesis. J. Bone Joint Surg. 1996; 78B: 951–4.Google Scholar
Saraste, H.Spondylolysis and pregnancy – a risk analysis. Acta. Obstet. Gynecol. Scand. 1986; 65: 727–9.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×