The shift in posture, of course, is one of the biggest changes. A wheelchair adjustment is necessary at this point, to accommodate these changes. The increased stiffness, especially with fusion to the pelvis, can make for some initial discomfort. Spence found he needed a molded seat to get comfortable, a change he wasn't expecting. Increased height can mean changes in feeding, since bending over to be close to the plate is not an option.
Transfer techniques change as well.
Taller seating also uses up headroom in the car or van. And while the neck vertebrae remain unfused, allowing normal rotation of the head, there is a significant change in the mechanics of moving the upper body as a whole, since rotation of the spine is no longer possible. Turning around involves rotating the entire upper body, and the pelvis, too, if it's fused. Planning for these changes before surgery, in consultation with occupational and physical therapists, can allow successful management of these problems.