Prince Eugenie was still a child when she had drastic surgery that left her with metal
implants and a fused spine.
But it could have been much worse.
When Princess Eugenie was 12 years old, doctors diagnosed her with scoliosis.
Her father Prince Andrew told the Royal National Orthopaedic Hospital that Eugenie's mother,
Sarah, Duchess of York, first noticed something was amiss when she watched Eugenie swim.
"It was discovered when she was about 12, while she was swimming."
Eugenie later wrote,
"[I was] told that I would need corrective surgery.
This was, of course, a scary prospect for a 12-year-old; I can still vividly remember
how nervous I felt in the days and weeks before the operation."
Scoliosis occurs when a person's spine starts to rotate, causing an unnatural sideways curve to form.
The severity of the curve differs from person to person — some experience curves that
are as mild as 10 degrees, while others can deal with a curve of up to 100 degrees or more.
Often, scoliosis can easily be seen on an x-ray because the spine forms an "S" or "C" shape.
This unnatural curve can cause plenty of problems, and in Eugenie's case, it was so extreme that
she needed corrective surgery.
Princess Eugenie's condition couldn't have been prevented, as doctors are still baffled
as to why some types of scoliosis occur in the first place.
80% of people who get diagnosed with this condition have no known cause.
This is referred to as idiopathic scoliosis, which is often diagnosed in children ten years
and older — this is on par with Princess Eugenie's diagnosis at age 12.
Idiopathic scoliosis typically runs in families, but there's no known gene that causes it.
Other types of scoliosis include neuromuscular scoliosis and congenital scoliosis.
The former is typically a result of one or the other neuromuscular conditions, like spina
bifida, cerebral palsy, and muscular dystrophy.
Because these conditions affect the muscles around the torso, the risk of developing an
unnatural spinal curve is much higher.
When the spine's vertebrae don't develop properly, it can lead to congenital scoliosis.
This can often be diagnosed in newborn babies.
Scoliosis might not be that obvious at first, but noticeable physical signs can occur as
the unnatural curve of the spine worsens.
For instance, one shoulder blade jutting out or uneven shoulders are some of the most common symptoms.
The fact that Princess Eugenie's mother could see something was off with her back while
she was swimming is a testimony to how severe her scoliosis was.
Some people's scoliosis can be observed when they bend over and one side of their back
sticks out more than the other.
Other physical symptoms include an uneven waist, hips, and rib cage.
While these physical symptoms can already be upsetting enough, the thing that affects
children's and especially adolescents' self-esteem the most is wearing a back brace.
Not only does it scream to the world that they're different, but it can also limit the
clothes they can wear and the activities they can participate in.
Princess Eugenie admitted to The Telegraph that she, too, had some self-esteem issues
prior to her surgery.
"I think the most upsetting [thing was] [...] having a condition that made me different.
As well as the idea that I would not be at school [after surgery], or be normal like
the other students."
Scoliosis can also cause extreme pain.
Healthline notes that the most common types of pain people experience are stiffness and
an ache located in the lower back.
Some people experience shooting pain in their legs.
In some cases, the pain becomes so extreme that patients have trouble navigating their
day-to-day lives.
And fatigue is another annoying symptom.
Extreme pain is a symptom that mostly affects adults with scoliosis.
Children might experience some mild tenderness in their back, but it is unlikely to be bothersome.
This is likely why Princess Eugenie and her family never knew she had scoliosis — she
probably never experienced any intense pain.
Had she not undergone the surgery, however, she would likely have dealt with chronic pain
as an adult.
The complications that can arise as scoliosis progresses can be quite severe.
Aside from chronic pain, patients can experience other distressing symptoms, like heart failure.
That's because, as the spine's unnatural curve continues to worsen, it eventually starts
to press on the rib cage, decreasing the available space and thus affecting the heart's ability
to function properly.
Heart failure isn't a common occurrence in scoliosis patients, but it is a possibility
if it's left untreated.
The restriction of the rib cage can also lead to respiratory problems because the lungs
no longer have optimal space to expand.
Aside from severely affecting the rib cage, untreated scoliosis can also decrease the
size of the spinal canal, which affects the nerves in this area and eventually leads to
leg pain and weakness.
When Princess Eugenie underwent corrective surgery for her scoliosis, she was bed-bound
for a couple of weeks, and it left her feeling incredibly frustrated.
Eugenie told The Telegraph that she was worried about how the surgery would change the way
her body could move.
She recalled thinking at the time,
"Will I be able to play sports, or will I look the same, or will I miss a lot of school
and be behind?
Afterwards, I couldn't move for a while in hospital or when I came home.
I had to wear a neck brace and be moved very gently in bed for a few months.
That was very frustrating and I remember being angry about not being able to run and play."
Eugenie's concerns as a kid mirror those of many other scoliosis patients.
According to the Scoliosis SOS Clinic, there are plenty of sports you can't do when you have scoliosis.
Weight lifting, dance, gymnastics, yoga, impact sports, and sports like golf, tennis, and
skiing – which Eugenie often did as a child – are off the table for many because they
can pose significant risks.
The surgery Princess Eugenie had at the age of 12 is known as spinal fusion, and while
it's said to be highly effective, it's also getting more and more expensive.
In 1997, the procedure cost $55,000.
By the time 2012 rolled around, it had gone up to $177,000.
This hefty price tag can make it challenging for some people to scrape together the money
to address severe scoliosis, especially those without health insurance.
When performing spinal fusion surgery, surgeons fuse implants like bone grafts, hooks, screws,
and steel rods with the spine to straighten it.
"I came here and they put metal rods in my neck, and 8-inch screws up my back, which
have now fused together and keep me straight!"
Scoliosis surgery can be risky.
Some people experience complications that lead to blood clots, vision loss, and even
nerve or neurological damage, and there's also a risk of muscle or dural tears, gastrointestinal
or digestive issues, and respiratory problems.
Medtronic notes that some patients' spines don't properly fuse with the implants, which prevents healing.
There's also the risk of malfunctioning implants, plus some patients experience vertebral degeneration
at the surgical sites.
A 2015 study published in Scoliosis found that post-surgery infection is very common
among patients who undergo scoliosis surgery.
Luckily, Eugenie came through the eight hour procedure without any lasting complications,
though she still has to have regular checkups.
In 2012, Prince Andrew said,
"Everything is absolutely wonderful, there's nothing wrong, and it is working as advertised,
and the rods are doing their job."
Even though Princess Eugenie isn't experiencing any issues with her spinal implants at present,
doctors are concerned about the longevity of some of the implants used in spinal fusion surgery.
Dr. Tony Nalda, who is a leading expert in chiropractic care and conservative scoliosis
treatment, wrote on his website that children who undergo the procedure may eventually deal
with potentially dangerous hardware failure.
"There is a significant gap in the research and data on the long-term effects of spinal
fusion 10, 20, and 30+ years down the road.
The reality is that we quite simply don't know how living with a fused spine will look
far into the future.
[...] I'm referring to screws coming loose and puncturing the spine, rods becoming weaker
over time and breaking."
While spinal fusion surgery is supposed to relieve scoliosis, Dr. Nalda warns that he's
seen plenty of cases where patients still suffer from pain and physical limitations post-surgery.
This is because of how spinal fusion changes the body.
"As a fused spine is held in place by artificial means, it's not only less flexible, it's also
weaker and more prone to injury.
In addition, the fused vertebrae and lack of movement affect the surrounding muscles
that support the spine; they become strained and tight."
Because of this, people who undergo spinal fusion may find that they have very limited
movement through their back.
Nalda explains that, because the spine is more prone to injury after the surgery, many
patients are too scared to try new activities for fear of hurting themselves.
Princess Eugenie, however, is still often seen hitting the slopes with her sister, Princess
Beatrice, when they go on their annual ski holiday, so for some, it is possible to enjoy
activities they love post-surgery.
There is evidence that scoliosis surgery can affect sexual health and even cause sexual dysfunction.
Spinal News International notes that it's known that anterior spinal surgery, which
is often the method used to correct scoliosis, has been proven to cause retrograde ejaculation in men.
When it comes to how this surgery affects women, however, research is still sparse.
A small 2017 study consisting of 22 women who underwent corrective surgery for adolescent
idiopathic scoliosis, as Princess Eugenie did, found evidence that these women were
more likely to experience symptoms of sexual dysfunction than other women their age who
hadn't undergone the surgery.
Common complaints from participants included a decline in orgasms, sexual arousal, and
sexual satisfaction.
It's unclear whether the surgery itself caused these symptoms or if scoliosis is the root cause.
Spinal News International adds that sexual changes are prevalent in around 30% of women
who undergo scoliosis surgery.
The outlet also notes that some early studies indicate that 40% of women experience altered
menstrual cycles post-surgery.
Scoliosis surgery can also present women with unique challenges when it comes to pregnancy.
It appears that Princess Eugenie didn't have the option of a natural birth for either of
her two pregnancies.
A source told People at the time that doctors performed a C-section to deliver her first
baby because of the princess' scoliosis surgery.
This isn't always the case, however.
Board-certified OB/GYN Mary Jane Minkin told People that it really depends on the patient
and how exactly their spine was altered during surgery.
In some cases, a natural birth is possible, but an epidural can't be administered thanks
to the placement of the rods.
This can make labor more challenging.
Dr. Nalda, M.D.
explains that, typically, patients with scoliosis aren't necessarily predisposed to pregnancy-related risks.
When it comes to labor, however, some complications could arise.
"For women whose scoliosis has caused crooked hips, there can be an increased number of
stalls during labor, as the baby can end up malpositioned.
For cases of scoliosis where the spinal curvatures are extreme, potential additional complications
include intense back pain and difficulty breathing due to lung impairment."
Princess Eugenie's surgery left a long noticeable scar down her back.
For many, this can be distressing and severely affect their self-esteem.
Those who undergo anterior lumbar interbody fusion also have scars on their stomach, which
is a concern for many women.
Eugenie admitted that when she was young, she used to hide her scar, and tried her best
to make it go away.
"I remember putting cream only on my scar for years after the operation."
But she eventually realized showing it off was helping others embrace their own scars.
Speaking to The Telegraph, the princess revealed that she wanted a wedding dress with an open
back, proudly showing her scar when she married Jack Brooksbank in 2018.
"I believe scars are like memories that tell a story on your body, that remind you how
strong you had to be, and that you survived to talk about it.
Be proud of the story you can tell and inspire people with."
"I have done it and been through it and want to be able to help as much as I can."