Can scoliosis be an indication for cesarean (C-section) section in pregnant women?

Scoliosis and Cesarean Section Indication

Scoliosis alone is NOT an indication for cesarean section in most pregnant women—vaginal delivery is preferred and safe for obstetric indications only. 1

Key Distinction: Scoliosis vs. Skeletal Dysplasia

The critical factor is whether the patient has isolated scoliosis (spinal curvature) or skeletal dysplasia (systemic bone disorder affecting pelvic anatomy):

Isolated Scoliosis (Including Severe Cases)

• Vaginal delivery is the standard approach, even with severe thoracic curves exceeding 60 degrees 2
• Cesarean section is performed only for standard obstetric indications, not for the scoliosis itself 2, 3, 4
• Studies demonstrate that 65% of patients with severe thoracic scoliosis achieve spontaneous vaginal delivery, with cesarean rates of only 17%—comparable to the general population 2
• No significant increase in obstetric complications (preterm birth, labor induction, emergency cesarean) occurs regardless of curve severity 4
• Even surgically corrected scoliosis with spinal fusion does not mandate cesarean delivery 4, 5

Skeletal Dysplasia (Systemic Bone Disorders)

• Cesarean delivery is recommended because pelvic anatomy in most women with skeletal dysplasia precludes vaginal delivery 1, 6, 7, 8
• The infant's cranium will be too large to pass through the altered birth canal regardless of fetal size or head dimensions 6, 7, 8
• This represents true cephalopelvic disproportion from maternal anatomical constraints 6, 7
• Cesarean can be performed with standard Pfannenstiel skin incision and low transverse uterine incision 1, 8

Clinical Management Algorithm

Step 1: Determine the underlying diagnosis

• Is this isolated scoliosis (spinal curvature only) or skeletal dysplasia (achondroplasia, osteogenesis imperfecta, etc.)? 1

Step 2: For isolated scoliosis patients

• Plan for vaginal delivery as the default 1, 2
• Assess cardiopulmonary function if severe thoracic curves present (>60 degrees) 2, 3
• Reserve cesarean for standard obstetric indications only 2, 3, 4

Step 3: For skeletal dysplasia patients

• Plan cesarean delivery early in pregnancy 1, 8
• Coordinate multidisciplinary care including anesthesia evaluation for airway and neuraxial anatomy 1
• Identify short-trunk variants requiring heightened cardiopulmonary monitoring 1

Anesthetic Considerations (Not Delivery Route)

While scoliosis affects anesthetic management, it does not change the delivery route decision:

• Regional anesthesia (spinal/epidural) succeeds in 99% of attempts, even with prior spinal fusion 4
• Provider refusal to attempt neuraxial anesthesia is rare and often unwarranted 4
• General anesthesia may be needed for severe cases with respiratory compromise, but this is an anesthetic—not obstetric—decision 9

Common Pitfalls to Avoid

• Do not automatically schedule cesarean for scoliosis patients without distinguishing isolated scoliosis from skeletal dysplasia 2, 3, 4
• Do not assume prior spinal fusion surgery mandates cesarean delivery—vaginal birth remains appropriate 4, 5
• Do not confuse anesthetic challenges (difficult neuraxial access) with obstetric indications for cesarean 4, 5
• Do not overlook cardiopulmonary assessment in severe thoracic curves, though this rarely affects delivery route 2, 3

Evidence Quality Note

The cardiovascular guidelines 1 establish the principle that cesarean is reserved for obstetric indications in structural conditions. The skeletal dysplasia guidelines 1 provide the highest-quality evidence (2018) specifically addressing pelvic anatomy and delivery route. Research studies 2, 4 consistently demonstrate safety of vaginal delivery in isolated scoliosis across multiple decades and curve severities.