MANAGEMENT OF LUMBAR SPINE FUSION

If you're like most people, you probably take your back for granted. Unless you experience pain, you likely don't think much about it. But when something goes wrong - whether it's an injury, arthritis, or another condition - that's when you start to realize just how important your back is.

If you have recently undergone a lumbar fusion surgery or you have been told you need one, you may be wondering what to expect in terms of your recovery. This blog post will provide you with an overview of the typical recovery process for lumbar fusion surgery. What to expect before surgery, after surgery and how physiotherapy can help. Keep in mind that everyone recovers differently, so your own experience may vary from what is described here. But knowing what to expect can help make the recovery process a bit less daunting. So read on for information about recovering from a lumbar fusion surgery.

Lumbar fusions can help to reduce low back pain

WHAT IS A FUSION OF THE LUMBAR SPINE?
A fusion of the lumbar spine is a stabilisation of two or more segments in the low back vertebrae. This can be effective at reducing painful movement of the affected segments. The fusion can cause structures at fault to be decompressed and correct deformities in the lumbar spine.

There are a few different methods of fusion that can be achieved by a surgeon. A cage, structural graft or spacer - all of which types of implants - can be placed in the low back. In order to do so however, the disc between the segments must first be removed to allow for the implant.

This blog will talk about lumbar spine fusions and the procedure preoperatively and postoperatively. If you require further assistance with postoperative rehabilitation following a lumbar fusion, please book an appointment to see us.

PLEASE CONTACT US ON: (07) 3172 4332 TO HAVE A CHAT WITH OUR FRIENDLY STAFF OR SIMPLY BOOK ONLINE ON: WWW.PHYSIOPHI.COM.AU

A graft stabilising the lumbar segments

PREOPERATIVE PHASE: STEPS BEFORE THE SURGERY
During this period, transparency regarding the operation should be discussed and made clear. This promotes confidence in the surgery and justifies the rationale for the type of implant used. The specialist will also discuss which technique for the surgery will be used. It is important to understand the differences as each will have slightly different preoperative requirements.

In the case of a posterior fusion - meaning the incision is from the back - this kind of approach affects one of the core muscles. The multifidus group of muscles sits adjacent to the spinal column and needs to be shifted aside to grant access to the lumbar vertebrae. This might affect the nerves that supply the muscle and therefore rehabilitation focuses on retraining that core muscle.

A posterior approach stabilises from the back of the vertebrae

For anterior fusions, an approach from the front of the abdomen is done. Part of the abdominal wall and the associated muscles will be cut into and therefore rehabilitation focuses on retraining the abdominal core stabilisers.

An anterior approach stabilises from the front of the vertebrae

In both scenarios, proper core activation is taught preoperatively so that proper technique can be conducted postoperatively. These exercises are listed below:

Transversus Abdominis & Pelvic Floor contraction

Activation of core muscles including pelvic floor

The basic exercise to activate core muscles and becomes the basis of all further progressions for core strength retraining

Supine Marching

A progression to core activation

Stretching will also help to maintain and improve range pre and postoperatively.

Knee-To-Chest Stretch	Supine Piriformis Stretch
Knee Rocking	Lumbar Rotation Stretch

POSTOPERATIVE PHASE 1:
1-6 weeks post-op:

• Commencement of physiotherapy 3-6 weeks post-op
• Mobility is the main focus during this time: Bed mobility, how to transfer, dressing, showering and walking
• Resumption of core strengthening from pre-op
• Gentle neural gliding to be started
• An example of some exercises given at this point:

Bridging Bridging helps with bed mobility postop	Neural Gliding Neural glides prevent neural tissue tension

POSTOPERATIVE PHASE 2:
6-10 weeks post-op:

• Gradual resumption of normal activities under supervision with therapist
• Exercising can be up to 30 minutes daily and can be done 4-5 times/week
• Continued neural gliding and core strengthening
• Commencement of light resistance program that avoids inappropriate loading of the low back - no lifting greater than 5kg

Supermans Supermans are a good progression that target core stability	Single Leg Bridging Single leg bridging can be a progression to bridging

POSTOPERATIVE PHASE 3:
11-19 weeks post-op:

• Return to work during this phase
• Continue and progress exercise program
• Work-specific functional training is important
• If work demands overhead lifting, appropriate weight restrictions must be in place as well as caution taken with all lifting overhead

Wall Push-ups

Retraining shoulder blade stability for overhead tasks may be required

POSTOPERATIVE PHASE 4:
20 weeks-12 months post-op:

• Restoration of pre-injury function
• Progressions towards full function/pre-injury level functional capacities
• Long-term spinal care - regular exercise coupled with good technique with all activities

Lat Pulldowns Further strengthening of the rest of the back ensures prevention of reinjury	Horizontal Rows Horizontal rows to strengthen the mid back

HOW CAN PHYSIOPHI HELP?

• Soft tissue release during the early stages of healing reduces tension and allows movement restoration.
• Advice and education meets expectations with reality, so that there are no incorrect assumptions about a lumbar fusion procedure and the postoperative pathway that follows.
• Exercise monitoring and progressions with us ensures short-term and long-term goals are met which synergises with returning to work.

DISCLAIMER
Lumbar fusions are big procedures to undertake. Having a reliable team behind you is vital to ensure the recovery process goes smoothly. Even before surgery, gathering all the information about the pathway can formulate a robust plan for your future. At Physiophi, we are always looking to the future, and your postoperative rehabilitation is no different. Book an appointment with us to get the most out of your back.

PLEASE CONTACT US ON: (07) 3172 4332 TO HAVE A CHAT WITH OUR FRIENDLY STAFF OR SIMPLY BOOK ONLINE ON: WWW.PHYSIOPHI.COM.AU

REFERENCES

1. Goel, A. (2017). Letter: Lumbar Fusion for Degenerative Disease: A Systematic Review and Meta-Analysis. Neurosurgery, 81(5), E64-E65. https://doi.org/10.1093/neuros/nyx421
2. Mayer, M. (2020). [Minimally invasive lumbar fusion techniques]. OperOrthopTraumatol, 32(3), 179. https://doi.org/10.1007/s00064-020-00665-9
3. Patel, D. V., Yoo, J. S., Karmarkar, S. S., Lamoutte, E. H., & Singh, K. (2019). Interbody options in lumbar fusion. J Spine Surg, 5(Suppl 1), S19-S24. https://doi.org/10.21037/jss.2019.04.04
4. Schnake, K. J., Rappert, D., Storzer, B., Schreyer, S., Hilber, F., &Mehren, C. (2019). [Lumbar fusion-Indications and techniques]. Orthopade, 48(1), 50-58. https://doi.org/10.1007/s00132-018-03670-w