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postop spinal fusion protocol

 
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postop spinal fusion protocol - April 10, 2008 7:51:57 PM   
sunshine20

 

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does anyone know of a good protocol to follow?
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RE: postop spinal fusion protocol - April 10, 2008 9:21:59 PM   
T_Thom

 

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What type of fusion? What discipline are you?

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RE: postop spinal fusion protocol - April 10, 2008 11:10:35 PM   
annpsu25

 

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Sadly, from what I understand, most Doctor's do not have a protocol to follow because "they did the surgery right" and they do not want to be liable is a patient starts feeling parasthesias or pain.

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RE: postop spinal fusion protocol - April 10, 2008 11:48:41 PM   
jlharris


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My protocol:  Don't have a spinal fusion

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RE: postop spinal fusion protocol - April 11, 2008 12:39:30 AM   
SJBird55

 

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Now, now, Jason.  There is a time and place for everything... Spinal fusion is required for spinal instability and spinal fractures.  My friend's brother (soldier) was injured in Iraq from an IED.  Let's just say that the major spinal surgery with multiple levels of fusions he has throughout his spine are a good thing. 

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RE: postop spinal fusion protocol - April 11, 2008 1:14:40 AM   
proud

 

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quote:

ORIGINAL: SJBird55

Now, now, Jason.  There is a time and place for everything... Spinal fusion is required for spinal instability and spinal fractures.  My friend's brother (soldier) was injured in Iraq from an IED.  Let's just say that the major spinal surgery with multiple levels of fusions he has throughout his spine are a good thing. 


True. Ortho surgeons are outstanding under those circumstances.

But...unfortunately back pain is big business and the grand majority of spinal surgeries are simply not required. Worse still is the outcomes can be really really.....really bad.

At least if I try to educate patients and sub group them effectively, the outcomes are quite good. But if not....the patient is not worse.

Spinal surgery.....avoid at all costs if you can.

(in reply to SJBird55)
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RE: postop spinal fusion protocol - April 11, 2008 6:26:00 AM   
Kaden

 

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I agree with the above about the general success or lack there of with fusions.

However, since they are still done and you asked for some protocol advice check the link below and scroll down to "L" section.

http://www.wbamc.amedd.army.mil/PatientCareServices/RehabProtocols/Alphabetical.asp

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RE: postop spinal fusion protocol - April 11, 2008 11:52:31 AM   
JSPT

 

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Get clearance from the surgeon to start exercise, asking if there are any precautions to follow.  No active extension past neutral is common with our surgeons. 

Otherwise, treat the patient like anyone else: what is tight, what is weak, where are the deficits.

I commonly work on abdominal stabilization/bracing, isometric trunk rotation, isometric trunk extension in neutral, glutes, hams, quads, lots of closed chain stuff like squats, quadruped progresssion, etc.  The pool is a good place to start if its available.

Progress to more functional movements when the stability is there, such as squatting onto a low table, overhead lifts, lunging, single-leg balance exercise, and so on. 

(in reply to Kaden)
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RE: postop spinal fusion protocol - April 11, 2008 12:06:15 PM   
SJBird55

 

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Nice site, Kaden.

I do a few different things than that protocol suggests.  Picture hamstring stretches... I'm not in my mind truly stretching the hamstrings - I'm targeting the sciatic nerve and it's ability to tolerate movements.  As I'm "stretching" the hamstring in supine, I'll also do slow continuous motion into hip internal rotation and external rotation and repeat over and over.  I'll at some point add passive dorsiflexion of the foot with an eversion factor.  When the person can sit and slouch, I have the person begin basically a gentle slump test as an exercise.

I also have the person begin resisted back extension in the seated position.  Depending on the patient and symptoms, I begin that anywhere from 3-6 weeks post op.

On another note, I never say one word about literature that reports spinal fusions are unsuccessful.  When someone walks in my doors after that kind of procedure - I am upbeat, positive and continuously provide the little improvements I observe. 

Surgeons have their own perceptions too.  When I was employed with a group of orthopaedic surgeons, there were 2 on staff that specialized in the spine.  I hear all of you on the poor outcomes from spinal fusions.  In my opinion, the reason the outcomes are poor is because the surgeons themselves are not subgrouping the patients undergoing the procedure.  Most of the literature dumps "spinal fusion" into a lumped category.  With this procedure, the surgeons have the same problem we do when it comes to literature that states physical therapy isn't effective.  I had the opportunity to be behind the scenes and hear and discuss crap with the surgeons.  The one surgeon was a trip... he'd look at the X-rays or MRI that the patient brought... then he'd go do his consult with the patient.  There were times that he'd come out of the room and he'd be giving me the "he's yours."  The surgeon would be grumbling about how patients with back pain think they should have surgery and he'd rant on to me that the patient didn't have leg pain, weakness or neurological findings.  This surgeon had a classification system of who would be candidates for spinal fusion surgeries.  The patients that I have treated of his post-op seemed to do well.  The experience behind the scenes was interesting.   This particular surgeon did failed surgeries too - I can't remember the years to failure, but I'm guessing 4-7 years.  He'd be SOO pissed too.  The failed fusion surgeries were originally performed by a neurosurgeon versus an orthopaedic surgeon.  (at least when I was standing there observing)  The predominant technique with the neurosurgeons (from what was shared to me) was the neurosurgeons used bone grafts.  This particular surgeon used something that looked like a metal cylinder or barrel on radiographs.  So, not only should research discuss the appropriate patients, but also which procedure was performed for the fusion.

(edit:  AND of course, it would also be good to know in the research on fusions the frequency that the surgeons have a "relationship" with the company that sells/manufactures the hardware and what that "relationship" entails.)

< Message edited by SJBird55 -- April 11, 2008 12:11:22 PM >

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RE: postop spinal fusion protocol - April 11, 2008 2:14:35 PM   
jlharris


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I don't tell pt's they are going to fail because they had a fusion.  I do tell pt's in the sub-acute phase that it is best to exhaust your conservative tx's before choosing spinal fusion for non-instability conditions (eg back pain only or disc herniation with radicular pain).

When I do get s/p fusion pt's it's months (6-18) after and often with the pt telling me "I'm having pain still because the bone isn't all the way fused yet".  What a bunch of crap.  But that is what the surgeon (or at least what the pt percieves the surgeon) is telling them as a way to explain away the continued pain.  Then, the Hx is idiopathic pain, 1 or 3 LESI's and then surgery.

It's gotta be nice when you can live off the outcome of "good alignment and bony fusion" and that's it.

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My PT Blog

(in reply to SJBird55)
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RE: postop spinal fusion protocol - April 11, 2008 5:22:54 PM   
SJBird55

 

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Jason, maybe that's the problem - physical therapy should be initiated WAY sooner than 6-18 months post lumbar fusion.  Those patients really can do quite a few activities postoperatively.  Often times they do need a lot of reassurance and postive comments.  I could be lucky in the sense that the ortho surgeons that do spinal surgeries in this area value physical therapists.  We only have 2 ortho surgeons who specialize in the spine and patients are referred for physical therapy services quite soon after the fusion.

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RE: postop spinal fusion protocol - April 11, 2008 7:32:36 PM   
Kaden

 

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Good points everyone.

SJ, I can't take credit for the site.  Duffy posted it over at PT update a while back, but I have definitely bookmarked the site.  Alot of good info and I too alter the protocols to my liking but a good starting place especially for a new grad.

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RE: postop spinal fusion protocol - April 23, 2008 8:53:16 AM   
scolipatient

 

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There is a 10-page article on this topic (PT for fusion post-ops) on the website of Christa Lehnert-Schroth, a retired PT who treated scoliosis patients for 50 years in her German clinic. Though specifically intended for scoliosis cases, some of the principles may apply generally. See:

http://www.schroth-skoliosebehandlung.de/

Click on the UK or US flag for English; on the left margin click "What Can Patients Do..."; then scroll down to download the PDF, "Physiotherapy for scoliosis patients following spinal fusion surgery." The scroll mechanism sometimes refuses to disentangle from your cursor -- you may have to click in the middle of the page a few times.

For a condensed overview of the Schroth method, browse the rest of the website. The section "Treatment Concept" has several other articles on the method, and there are references to a new book in English.

The Schroth method for scoliosis has been mentioned a few times on this board over the past half-dozen years. It's physiotherapeutic treatment that's been practiced in Germany since the 1920s. Schroth-trained PTs have recently begun treating patients in Wisconsin, Maryland, California and a few other states. See the homepage of the National Scoliosis Foundation (www.scoliosis.org) for a list -- scroll down towards the bottom of the page. I believe that Beth Janssen in Wisconsin (who has posted at rehabedge) has treated post-ops (www.scoliosisrehab.com), and Beatriz Torres in California is a scoliosis post-op herself as well as Schroth practitioner (www.scoliosispt.net).

< Message edited by scolipatient -- April 23, 2008 9:01:09 AM >

(in reply to Kaden)
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