Cushion Recommendations for Post-Spinal Fusion Recovery in Scoliosis
For a person recovering from recent spinal fusion for scoliosis, a foam cushion or pillow should be used primarily for head and neck support when lying supine, while three-sided foam positioning blocks are recommended for knee support to maintain proper spinal alignment during the healing period. 1
Positioning During Recovery
The primary goal during spinal fusion healing is to maintain proper spinal alignment and minimize stress on the fusion site. The evidence provides specific guidance on positioning aids:
Supine Positioning (Primary Recovery Position)
- A foam cushion or pillow should support the head and neck when the patient lies flat on their back 1
- Three-sided foam blocks (offering three height options) should be placed under the knees to help flatten lumbar lordosis and reduce stress on the fusion site 1
- The patient should maintain a flat position with limbs and trunk aligned to the body's midline as closely as possible 1
Critical Positioning Principles
- Hip and knees should be flexed to 90° when lying supine to reduce physiological lumbar lordosis and increase intervertebral spaces 1
- The spine must remain in a neutral position with arms at the sides of the body 1
- Legs should remain straight and feet uncrossed when not using the knee support 1
Important Considerations for Scoliosis Fusion Recovery
Avoid Bracing Unless Specifically Indicated
Postoperative bracing following instrumented posterolateral fusion is NOT recommended, as equivalent outcomes have been demonstrated with or without bracing 1. This is based on Level II evidence showing no benefit to routine postoperative brace use 1.
Sitting Cushions Are Not Addressed in Guidelines
The available evidence focuses on positioning for imaging and postoperative recovery protocols, but does not provide specific recommendations for sitting cushions during the healing phase. However, the principles suggest:
- Any cushion used should maintain neutral spinal alignment and avoid excessive flexion or rotation 1
- Pressure distribution should be even to prevent localized stress on the fusion site 1
Common Pitfalls to Avoid
- Do not use cushions that promote excessive lumbar lordosis during the early healing phase, as this increases stress on the fusion construct 1
- Avoid positioning that causes rotation or lateral bending of the spine, which can compromise fusion healing 1
- Do not rely on lumbar support braces as they provide no proven benefit after instrumented fusion 1
Recovery Context
Adult scoliosis patients undergoing fusion to the sacrum have high complication rates (78% in one series), with loss of lordosis being a significant concern requiring corrective procedures in many cases 2. Careful preservation of lumbar lordosis during recovery is essential 2. Long-term outcomes after posterior fusion for scoliosis are generally good, though patients who develop positive sagittal balance (leaning forward) have worse outcomes 3.