Brief overview of the surgery

1. Spinal fusion is a surgery used to connect two or more vertebrae to provide stability in the spine.  An incision is made to provide visibility to the spine. 

2. Muscles and tissues are moved aside. Damaged discs/tissue is removed. 

3. The surgeon can use screws, rods, or bone grafts to fuse the spine. 

4. This surgery is done treat degenerative disc disease, severe pain, instability, and degenerative spondylosis. 

Post - operative precautions

1. AROM after 8-10 weeks

2. Avoid exercises that reproduce or increase pain

3. No BLT- usually up to 3 months, may be up to 6 months

1. Oswestry Disability Index - minimally important change is 10 points. 

2. Roland-Morris Disability - minimally important change is 5 points. 

   1. Roland-Morris Disability Questionnaire is most sensitive for patients with mild to moderate disability due to acute, sub-acute, or chronic low back pain. 

Numeric Pain Rating Scale - minimally important change is 2 points.

Rehabilitation Phases with specific exercises and recommended dosages

1. Phase 1: Immediate post surgical phase 0-8 weeks

   1. Educate on precautions (no BLT), brace w/ OOB activities

   2. Pain management (education)

   3. Promote Post-Op exercises including Bed mobility/exercises 

      1. practice log roll (until safe and efficient)

      2. LAQ/SAQ/ankle pumps: 3x10 with 10 second hold @ top/bottom

      3. TA activation: 3 min w/ 10 sec holds

      4. breathing exercises: square breathing 3x1 min

   4. Walking with brace and LRAD: monitor pain and keep within 2 points of resting pain

   5. Educate on precautions (no BLT), brace w/ OOB activities

2. Phase 2: OP-PT 8-12 weeks 2/3X a day

   1. Manual Therapy

      1. Gr 1 and 2 joint mobilizations

         1. P-A mobilizations

      2. Soft tissue mobilization (Effleurage, Connective tissue)

         1. Multifidus, Erector Spinae, etc.

   2. Exercises

      1. Bike (6 min warm up)

      2. Multifidus activation- side lying 3 min w/ 5s hold

      3. Lumbar Tilt- 10s hold 2min

      4. Multifidus and TA co-contraction:  

      5. Bent knee fallouts: 2 min

      6. Clamshells: 2x30, 30 sec rest

      7. Sidelying hip abduction/adduction: 

      8. Dead bugs (Wk 10-12)

      9. Leg ext in qped: 

      10. Stretch major leg muscle groups: 3x30s

      11. Single leg stance: 3x30s

3. Phase 3: Advanced PT 12-18 2-3X per week 

   1. Manual: 

      1. Soft tissue

      2. Joint mobs above and below

   2. Exercises: 

      1. Dumbbell passes: 3x each leg, 30s

      2. Bird dogs: 

      3. Chops (D1/D2): 

      4. Farmer Carries: 30 yards x 5

      5. Bridges in unstable surface: 

      6. Paloff press + walk outs: 30 each way

      7. squats/sit to stands: 3 min

1. Phase 1: 

   1. Pain and swelling within tolerance.

   2. Independent HEP

   3. Tolerance of 15 min of exercise and 15-30 min of cardiovascular exercise.

   4. Functional ADL for self care/hygiene

2. Phase 2: 

   1. Patient has working knowledge of body and lifting mechanics.

   2. Able to hold co-contraction of multifidus/transverse abdominis for 60 sec

   3. Cardiovascular tolerance to 30 min/day

   4. Dynamic sitting and standing tolerance of 15-60 min