By David K. Wolpert
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You are surely wondering whether fusing your spine will limit your flexibility. Will you still be able to bend over? Bend to your side? Arch your back? Without question, scoliosis surgery will limit your ability to do all these things somewhat, but the extent to which your flexibility is limited will vary based on what specific vertebrae are fused. Not every one of the 24 vertebra in your spine are involved equally in your ability to bend your back.
Your five lumbar vertebrae (L1-L5) are the most important for maintaining flexibility. Every surgeon will try to avoid fusing these vertebrae if possible, though fusing just L1 will not have a significant impact on one's flexibility. Some lumbar deformities are so severe, however, that a surgeon must fuse "down to the sacrum"—fusing all five lumbar levels and anchoring the instrumentation to the sacrum. Adolescents are rarely fused to the sacrum, whereas adults are sometimes fused to the sacrum when there is severe disc degeneration between the lower end of the curve and the sacrum. Fusing to the sacrum will, unfortunately, result in a substantial loss of bending flexibility.
The seven cervical vertebrae are the second most important area in terms of flexibility. Spinal fusions for correcting scoliosis rarely fuse vertebrae high in the neck, but even the lower cervical vertebrae are substantially involved in your ability to bend and rotate your neck. The 12 thoracic vertebrae are the least important to bending flexibility. Because these vertebrae support the rib cage, they do not bend much even in a normal spine. A fusion limited to the thoracic region will therefore not result in significant bending limitations.
It is important to understand that people who have spinal fusions learn to compensate for reductions in flexibility. They bend more with the other, non-fused sections of their spine, and they bend more from their hips and use their legs to get closer to the ground. Your overall flexibility may be diminished, but your functional ability to continue doing the things you want to do is not usually as reduced as you might expect.