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      • Standing Forward Flexion Test
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      • Supine to Long Sit Test
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      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
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        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
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      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
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      • Moving Valgus Stress Test
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      • Ulnar Nerve Compression Test
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      • Varus Stress Test
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      • Phalen's Test
      • Reverse Phalen's Test
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      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
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      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
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    • Foot/Ankle >
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      • Test for Interdigital Neuroma
      • Windlass Test
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Is It Okay To Have a Spinal Fusion?

6/13/2016

4 Comments

 
One of the procedures that is heavily being researched these days is fusion of lumbar vertebrae. The theory revolves around the idea that a painful segment is dysfunctional due to "decreased disc space" or hypermobility. The procedure involves decompression and the fusion of the segments, so that pain and compression can, theoretically, no longer come from the segment.

One of the obvious issues with this procedure is that it almost guarantees further degeneration and pain at the above and below segments (if you are looking at it pathoanatomically). Why? Because, in a given motion, like lumbar flexion, the force and mobility is supposed to be relatively evenly dispersed throughout the entire region. When one of the segments becomes fused, greater motion must occur at each joint, but especially at the ones directly above and below. This hypermobility leads to increased degeneration and then hypomobility and possibly pain (again assuming pathoanatomical perspective).
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The other major concern is that the surgery typically doesn't have that favorable results. Previous research had said that lumbar fusion had only a 25% success rate. With the risks of any invasive procedure, I know I wouldn't want to pursue it. More recently, a study revealed that fusion is no better than non-operative care for chronic low back pain. Again, with the risks, why go through with surgery?

Personally, I recommend avoiding lumbar surgery in almost all cases. The risks and low success of surgery typically aren't with it, in my opinion. However, there are cases where I do recommend fusion of the spine. For example, worsening neurological signs that do not improve with conservative management, fracture, and other similar findings. There are cases where severe future injury can be avoided with surgery, like cauda equina syndrome. Lack of progress may indicate the need to switch treatment approaches, but progressively worsening symptoms may indicate the need for a surgical consultation.

-Chris

If you are looking to improve upon your clinical skills and orthopaedic knowledge, consider joining OPTIM's COMT program. With OPTIM, you can expect a residency-like learning experience without breaking the bank, all while learning from highly skilled physical therapists. Check out optimfellowship.com for more information!
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4 Comments
best essay service link
3/2/2017 02:22:32 am

This is a science article many student are use for gaining the knowledge. Many children are totally focus on mission and gaining the knowledge. All the student is try to become a good student in class.

Reply
McdonaldsGutscheine link
5/13/2017 11:12:51 am

Thank you for taking the time and sharing this information with us. It was indeed very helpful and insightful while being straight forward and to the point.

Reply
Dorian link
5/23/2018 10:46:17 am

My biggest concern with spinal fusion is the lack of mobility it causes.

Reply
Dorian link
5/23/2018 10:47:40 am

Great article, I would also recommend everyone try PT and Chiropractic treatment options before option for a surgery that carries the risks that fusion does.

Reply



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  • Home
  • About Us
  • TSPT Academy
  • Resources
    • Newsletter
    • Orthopedic Blog
    • Featured Articles
    • Research Articles
    • Residency Corner
  • Special Tests
    • Cervical Spine >
      • Alar Ligament Test
      • Bakody's Sign
      • Cervical Distraction Test
      • Cervical Rotation Lateral Flexion Test
      • Craniocervical Flexion Test (CCFT)
      • Deep Neck Flexor Endurance Test
      • Posterior-Anterior Segmental Mobility
      • Segmental Mobility
      • Sharp-Purser Test
      • Spurling's Maneuver
      • Transverse Ligament Test
      • ULNT - Median
      • ULNT - Radial
      • ULNT - Ulnar
      • Vertebral Artery Test
    • Thoracic Spine >
      • Adam's Forward Bend Test
      • Passive Neck Flexion Test
      • Thoracic Compression Test
      • Thoracic Distraction Test
      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Leg Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
    • Hip >
      • Craig's Test
      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
      • Hip Quadrant Test
      • Hop Test
      • Labral Anterior Impingement Test
      • Labral Posterior Impingement Test
      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test