Spinal Fusion

Rehabilitation for individuals who undergo spinal fusion will depend on the level of the spinal involvement, the number of segments fused, the type of instrumentation used, the individual's bone quality (normal or osteoporotic), and the preoperative status of the individual. Throughout rehabilitation, special attention must be paid to protect the integrity of the fusion until imaging establishes that solid fusion has in fact occurred. All rehabilitation must progress based on the recommendations of the surgeon.

The immediate focus after surgery is to promote independent transfers and ambulation in order to allow the individual to reach independence in activities of daily living. Assistive devices may be used, with a rolling walker on level surfaces often recommended. Proper transfer techniques must be taught, emphasizing log rolling for all bed transfers. Occupational therapy may be useful for training in activities of daily living and providing assistive devices that may be useful during recovery (Christensen).

At approximately 4 to 6 weeks postoperatively, or when recommended by the surgeon, isometric training of the trunk muscles can be initiated. General conditioning exercises of the upper and lower extremities, and aerobic training are initiated and progressed as indicated. Activities that promote trunk flexion should be avoided until approved by the surgeon. A short course of cognitive pain management as a part of a multidisciplinary intervention may be beneficial for individuals who underwent this type of surgery (Mayer).

Once trunk flexion is advised, then general trunk flexibility, strengthening, and endurance exercises can be taught and progressed as tolerated.

An ergonomic assessment may be beneficial to modify the workplace as needed and ensure the work status of the individual.

Controversy exists in the literature regarding the benefits of conservative management versus a surgical approach (Brox).