Sometimes, despite all of our best efforts and intentions in life we can become injured or suffer an unfortunate traumatic event that requires us to have surgery. There are multiple different surgical options for the lumbar spine that depending on your condition, a surgeon would help to decide what is the best option for you. One common one that we see is a low back fusion.
Lumbar fusion surgery is considered in a couple scenarios. The first being the presence of significant instability, excessive motion, in the spine as the result of a trauma that puts the spinal nerves at risk. The second main scenario is failed conservative care for degenerative conditions of the spine. Sometimes our bodies just don’t respond to conservative care and that low back pain, dysfunction, and poor quality of life persist even with good treatment. In these instances, in consultation with a surgeon, a fusion may be performed to improve space, stabilize the spine, and restore function to the spine.
Simply put, a lumbar fusion is when rods and screws are placed into the bones of the spine, usually spanning two or more bones and disc(s) to limit motion at that area of the spine. With that portion of the spine now fused, the damaging excessive movement or cramped space contributing to the pain has now been remedied and the spine can begin to heal.
Physical therapy is an important part of the recovery process just as it is with a knee replacement or rotator cuff tear. The fusion will address the bony structure of the spine, but the physical therapy will help to restore muscle control, ROM, strength, and function around the fusion to protect it and maximize the benefit that you can get from the surgery.
Often times following a surgery our muscles do not work the same due to the movement associated with surgery. We develop compensations, walk with a limp, and feel weak. These don’t spontaneously resolve themselves.
Physical therapy can help to address all of those while protecting the surgical site. Care must be taken, especially in the early stages following surgery to move in certain ways to avoid stress to the healing fusion. Physical therapists can do a great job of helping you to navigate these early weeks and then when ready, begin to load and strengthen your entire body to promote full function.
To be clear, the first line of defense for low back pain should be conservative, including physical therapy, medication, injections. When consulting with a medical team that includes both a physical therapist and orthopedic surgeon, all conservative options should be exhausted before considering surgery.
In certain instances surgery may be considered the first line of defense to prevent significant long lasting injury. These include a significant trauma like a car accident, fall from a large height, or other red flags such as progressive muscle weakness, loss of muscle mass, inability to control bowel/bladder among others that your medical team will detect. These are typically emergency situations and surgery may be necessary. Once those conditions have been ruled out, consider all conservative options before having surgery.
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