(Not sure if this is a better fit for Medical or Training forum but here goes)
I am interested in hearing experience from training others or training yourself for individuals who experienced a spinal fusion into the lumbar during adolescence. My interest is in learning what others have found possible/impossible with a fusion that goes into L3 - L4
range.
We are working through some difficult decision making with our daughter that may require a fusion (adolescent scoliosis). I’m not looking to turn her into a powerlifter, I’m more interested in hearing any experience of what people in this situation can and can not do in the gym, which for me is another “future quality of life” data point.
Also - would love a podcast on the subject of scoliosis if the Drs. feel equipped to discuss it!
Dr. Miles - thanks for the thoughtful response. Since you ask (and I think I can see how my initial post wasn’t super clear on the extent of the fusion) I’ll add some context.
Her curve is a bit more pronounced - approximately 46 degrees in the thoracic and 50 in the lumbar, and she still has some growing to do at age 13. Our understanding is that this is well into the range that warrants intervention. There is also a rotational component. I should have said the fusion would go “as low as” L3 - L4, the reality is it would likely run from around T3 - L3 +/- depending on what the surgeon feels is best. We realize this is probably going to limit motion and flexibility to some degree, which is what has me curious around what you all have seen (if anything) in the real world post operation, with strength training as a proxy for what someone is capable of or limited to.
There is a tethering procedure out there as well which is a way to avoid the fusion and preserve the natural spine - however it is newer and comes with risks of
not working and requiring revisionary surgery, or
not working “well” - as it it corrects it from a clinical standpoint but leaves some visible curvature/rotation, and
no long term studies yet (procedure is only about 10 years in, and about 4 - 5 years in the US). So we are kind of in a place of “can we get comfortable with a fusion outcome” (lots of examples of people living normal, active lives and doing activities they enjoy) vs. taking a chance on a surgery that may or may not work as well as desired to avoid such an invasive procedure.
This makes a lot more sense in terms of overall level(s) being fused. The degree of curve here would likely warrant some intervention as well. I don’t know the extent to which you have attempted exercise and bracing interventions, but that would also still be on the table. If they are doing a standard fusion procedure for that many levels, there will be some mobility restrictions but I would venture a guess with the level of curves you are reporting, some of that already exists.
I have seen more than a few of these over the years and overall they do well. I’ve had athletes return to playing basketball, running, dance, and lifting off the top of my head. The big things early on are working to stay active within limitations and trying to keep a positive outlook as things heal. It is pretty boring for the first 8-12 weeks then the options open a lot.
As far as the tethering procedure, my personal opinion is I stay away from new procedures. Historically, every new procedure has good short term outcomes due to the case study nature of reporting. Until something can show me at least 5 year outcomes, I do not know that I would put much stock in it. Once again, fully admitting my bias here. What I will say is I would have a conversation with your surgeon that the goals are to be able to be active through adolescence and adulthood. To your point, it is one thing to correct a curve and another altogether to be able to do all the things a person wants.