The concept of spinal fusion has been around for decades and is undergoing consistent refinement as newer techniques are being developed. Dr. Mobley has been trained in both minimally invasive and traditional approaches to spinal fusion. The decision on what approach to take is only make after patient specific physical examination and diagnosis. A lumbar spinal fusion is most commonly recommended in circumstances where a patient has an unstable spine, either by means of years of degeneration or by traumatic fracture, that puts the patient at risk of neurological damage. It is also recommended in cases where a patient is having life altering low back pain that has failed all conservative measures. This approach may also be required when decompression of neural stuctures (freeing up nerves) will cause the spine to become unstable. In this case, it is the structural supports that are directly compressing neural structures and removing them is required to alleviate the patients symptoms. The consequence is that support taken away must be replaced. Whatever the case may be, a spinal fusion is really a stabilizing procedure using fixation screws and connecting them with rods. This intevention isolates and stops motion in the area causing problems so that the body in the post operative recovery period can heal and lay down bone in the area. This new bone that is created is the permanent bridge that will fixate two or more vertebrae into one. So in the end, it is the body itself that creates the actual fusion and the surgery itself serves to set the stage for this to occur.
6 months is the duration of recovery for a lumbar fusion. Prior to this time, restrictions will be in place unless imaging confirms solid bone growth at the surgical site. Once solid bone growth is confirmed, the patient can begin activities as tolerated without restrictions.
Walking is the KEY exercise. We want our patients walking post-operative day #1 and gradually advancing the distance they are able to walk throughout the recovery process. We do not put distance parameters on our patients because everyone will recover differently. What we are concerned with is progress and that the patient is walking further each week. We will want to know about any plateaus or setbacks in the recovery process.
The process of recovery can be divided into intervals as follows:
The first 2 months are a time for muscle healing and early bone growth. This is the time when the patient should consider their lumbar spine immobile. Visualize a pole that goes through your back which will not allow bending. The bending, therefore, must occur at the hips and the knees. This is an important concept because, while your hardware provides rigid fixation where we want bone to grow, reminding yourself to maintain good posture will create a longstanding habit that will help you successfully navigate the recovery period. During this time 10lbs is the most that we want our patient to lift. Keeping objects close to the body and avoiding reaching to grab objects will help minimize flare ups.
During months 3-4 muscles continue to heal and bone continues to form. This is the time that physical therapy is introduced into the recovery period. Physical therapy is great for introducing the patient to isometric exercises. Isometric exercises of the lumbar spine allow the patient to begin strengthening the spine musculature without range of motion. The goal of these exercises is to create a scaffold of muscle around the spine that not only aids in recovery but provides a long term foundation of core strength and minimizes the chances of future injury. Your therapist will also work on range of motion for other parts of your body and towards the end of this interval begin to introduce you to range of motion in the lumbar spine.
At months 4-6 your post-operative fatigue should be mostly gone as this interval starts. The restriction of weight is upped to 20lbs. Again, keep anything you carry close to your body and avoid repetitive bending, twisting or lifting. This is the time interval where your back pain from surgery should be all but gone. Stiffness and muscle soreness may still arise but the key is progressive improvement. This is the time when the patient is working on home strengthening and range of motion exercises they learned through physical therapy.
At 6 months we reached the landmark time interval where all restrictions can be lifted and the patient can resume all activities without restrictions. Here is a point where the patient will want to utilize common sense and gradually ease back into high intensity activities.