Colin Nnadi, orthopaedic spinal surgeon, Oxford University Hospitals

Most of the advice given to you about how to manage post-fusion centres on those important first 6 weeks of recovery. What about months down the line or even years after fusion surgery? We answer your frequently asked questions on life after fusion with the help of Consultant Spinal Surgeon, Colin Nnadi.

Are there activities I shouldn’t do, even if I’m many years post-op? e.g., Skydiving, trampolining, or going on rollercoasters?

What you want to avoid is an intense sudden jolt. People who’ve had spinal fusion are at greater risk of dislocation above the fusion and there is a risk of the metalwork snapping in an accident. A smooth landing in skydiving or a roller coaster where you’re well secured doesn’t necessarily pose a threat, but if you end up in a situation with an intense sudden jolt, you’re more at risk than a person who hasn’t had fusion. There has to be a bit of common sense to choose the safest way to do something, jumping up and down on a trampoline isn’t the risk, but trying to do a flip that ends with you landing badly is a riskier move.

Pain/discomfort years after surgery. How normal is it and when should I see someone about it? Are there reasons to have a follow-up appointment with a scoliosis specialist years after being discharged?

A certain level of aches and pains even after you recover from surgery is normal. Exercise that strengthens your muscles will help you to cope with this. Particularly popular in the scoliosis community are low impact exercises like swimming, yoga, and Pilates. Pain becomes a concern when it’s persistent and is interfering with daily living or if you’re relying on pain killers to get you through the day, it’s interfering with your sleep, work, or everyday activities, then you should be checked by a scoliosis specialist. They will ascertain the source of pain from history and examination and pursue non-operative measures to control symptoms.

Will my ability to do high-intensity or high-effort sports and activities be diminished post-fusion?

You will retain the ability to do most activities but the change in your range of motion might limit the techniques you’re able to do, impacting your ability to compete at the same level as your peers. There are exceptions to this and it’s not always the case but it’s a discussion we have with patients who are involved in certain sports at a competitive level.

Will fusion change the way I bend/twist/lift?

The change in the way you bend and lift will depend on the length of your fusion. A fusion of your thoracic spine might not make that much of a difference as it’s already an intrinsically stiff part of our back. A long lumbar fusion will change the way you bend, meaning you will be limited to bending at the waist, hips and knees. If you’re picking something up off the floor, make sure you’re bending at the knees, which is the proper technique recommended to anyone picking something heavy up anyway. You’ll have to get used to pivoting instead of twisting, rotating your feet and pointing your whole body in the direction you want to go, instead of twisting at the spine.

Is feeling or seeing the metal in my back normal?

This isn’t unusual and is more likely if you have a slight build or have had some weight loss. What is a concern is if the sensation of feeling the metal work is sudden and comes with pain. You should immediately speak to your doctor if this happens so that you can be seen by a scoliosis specialist.

Is there a risk of the non-fused parts of my spine curving?

This risk does exist, more so if a child who is still growing has been fused. Signs of this will usually show within a year of the surgery. Most scoliosis centres will not discharge you until a year after surgery, sometimes 2 years. You’ll have several check-ups in that time to see how you’re doing and that the fusion is taking successfully. At each follow-up appointment you’ll be cleared for more of your activities to return to normal.