I absolutely love to travel, and one of my favorite places is South East Asia. I’ve spent the most time in Thailand, the Land of Smiles, where a common phrase is, “Same Same But Different.” Same Same But Different means subtle differences or subtle nuances. My friend Megan and I took this picture in a tuk tuk in 2015. The picture screams, “Same Same But Different,” in oh so many ways! And interestingly, the phrase also applies to scoliosis surgery.
I love teaching classes for people who have experienced scoliosis surgery. There’s something very comforting in creating a space and moving with people that share this common experience. I felt this the first time I took Mimi Rosetti’s yoga and scoliosis spinal fusions class nearly ten years ago in New York. I’d never talked with another movement practitioner who also had a scoliosis spinal fusion, and it was SO exciting!!! I love that clients comment about how a sense of community can play an important role in their wellness journey and how this sense of community contributes to a feeling of normalcy.
Simultaneously, I appreciate how we each have differences so I thought I’d share some reflections on these nuances:
Age comes in to play in two ways. One is the age of the individual at the time of scoliosis surgery. Some of us have surgery quite young or into teenage years while others have surgery later in life. Some people who have their original scoliosis surgery at a young age undergo revision surgery later in life.
Another way that age comes into play is our current age in this very moment. Just like people without fused spines, a teenager will move differently than a thirty year old or sixty year old. This applies to us too. When I first had scoliosis surgery at age twelve, I couldn’t really feel the difference in my body once I was released to all my regular activities (I was told I could do everything except for horseback riding the first year. Gymnastics was the only activity forever off the list.). But now in my forties, oh yes, I do feel that fusion!
Fusion length also impacts how we move. I had a selective thoracic scoliosis surgery in that my fusion is only in the thoracic from T3-T10. This means I have an unfused lumbar scoliosis curve. Meanwhile, I have clients with fusions only in the lumbar. Some of these clients have unfused thoracic scoliosis curves and some have hyperkyphosis in their thoracic. I also have many clients with spinal fusions from the thoracic down into the lumbar. Some have fusions from the last lumbar L5 vertebra to the sacrum as well as the sacrum fused to the ilium at the sacroiliac joint (fused at the pelvis).
We all had various scoliosis patterns at the time of scoliosis surgery. We had different Cobb angles, angles of trunk rotation, shoulder height discrepancies, pelvic shifts, etc. Though the fusion “corrected” the spine, it didn’t change the neuromuscular patterning. And sometimes the scoliosis pattern in the unfused vertebrae may change from time of scoliosis surgery throughout one’s life. One of the best things that we can do is learn about our scoliosis pattern and continue to work on keeping areas of collapse expanded, lengthened, and stable.
Sagittal curves also differ from person to person. Sagittal curves are the natural curves that go forward and backward in the spine. Generally, the neck and low back round towards the front of the body (lordosis) while the mid back rounds towards the back of the body (kyphosis). Some clients with older instrumentation from the late 80s and earlier, including myself, may have flattened spines with some or much of the natural sagittal curves missing. This is referred to as Flatback Syndrome. Some clients who experienced scoliosis surgery later in life may have lost the natural lordosis of the low back and had it restored during surgery. One of the best things that we can do is try to maintain our sagittal curves in the unfused segments and surrounding soft tissues.
All of us have different levels of health and degeneration in our unfused segments. In particular our adjacent segments right above or below the fusion are at risk for degeneration. They absorb a lot of the movement that the fused spine can’t because, well, it doesn’t move. One of the best things that we can do is learn how to stabilize the area around the adjacent segments! In addition, some of us may have other concerns such as herniations, stenosis, or spondylolisthesis in our unfused segments. Plus, there’s the rest of our joint health to consider (feet, ankles, knees, hips, shoulders, elbows, writs, hands!).
Many people have bone grafts as part of their scoliosis surgery. These bone grafts may come from the pelvis or a rib and sometimes (but not always) require a separate incision. I have a client that experienced one of the first spinal fusions where her lower leg bone (tibia or fibula) was used. My bone graft came from the back, topside of my right pelvis and has a different incision than the one for my fusion. Sometimes, these bone grafts cause concern later in life so I think it’s important to be aware of where your bone graft came from if you had one. Not everyone has a bone graft because sometimes synthetic material is used.
The last thing I’ll mention (for now) is instrumentation and approach. Instrumentation varies and may include rods, plates, screws, cages, hooks, and wires. The instrumentation holds the bones in place while the spine fuses with the aid of a bone graft or similar synthetic material. In addition to different types of instrumentation the materials differ – titanium, stainless steel, cobalt chrome is common. Sometimes the surgeon accesses the spine from the back (posterior approach) and sometimes from the front (anterior approach).
Because we’re Same Same But Different, I always suggest that people obtain a copy of their surgical report as well as x-rays pre and post-surgery. These are really helpful documents to have later in life.