1. Rehabilitation Following Lumbar Spinal Fusion By: Alexandra Basciano

2. Lumbar Spinal Fusion basic idea is to fuse together the painful vertebrae so that they heal into a single, solid bone eliminates motion between vertebrae prevents the stretching of nerves and surrounding ligaments and muscle takes away some spinal flexibility

5. Right after surgery… IMMOBILIZATION! Back brace, internal fixation Slow gentle movements It may be several months before the bone is solid Light activity such as walking

6. Specificity Because surgeons use different techniques and approaches during fusion (for example, access to the spine can be achieved through incisions in the front, the back or both), some exercises may not be appropriate for all patients

7. Acute Phase Ice (no heat) active stabilization for supporting muscles Limit exercise to short walks Getting out of a chair walk as often as the surgeon allows, to the point of minor aching, but stop if there is any sharp pain Mobile scar

8. Acute cont. Rehab immediately, all pain w/in tolerance! Start working on flexion Lateral flexion (side to side) Hip adduction/abduction

9. Subacute Phase Start stretching to maintain flexibility Stabilization exercises Static to dynamic Low impact conditioning Begin electro stimulation therapy and ultrasound Ultrasound contraindicated with any orthoaftercare patients with metal devices

10. Start stretching! Gentle stretching promotes flexibility middle back where the nerve root is located (mobile scar) Very gentle stretching of the core back and abdominal muscles, as well as the hip muscles attached to the spine and pelvis 30 second holds, three repetitions, two sets per day

11. Double Knee to Chest Stretch Lay on back, knees bent Pull both knees into chest until a comfortable stretch is felt in lower back Keep back relaxed

12. Hamstring Stretch A seated hamstring stretch can be performed while sitting on the edge of chair. Straighten one leg in front with toes pointed up and knee straight. Push belly forward to move into stretch while keeping chest high. Static

13. Quadriceps Stretch The quadriceps flexion stretch is done while lying on the stomach, and bringing heel toward buttocks as far as possible Static

14. stabilization exercises should be completed by moving arms and legs while avoiding any rocking or arching of the lower trunk A pelvic tilt involves lying on your back on the floor with knees bent and pulling the belly in towards the spine. This position is the basis for keeping the lumbar spine stable Static

15. Stabilization exercises cont. Bridging: Form a bridge with trunk raised by raising hips from floor and keeping a straight line from shoulders to hips. Activates abs/core muscles as well as back muscles static

16. Dynamic After about 6 weeks dynamic movements can be incorporated into the rehabilitation program Up the intensity using an exercise ball or resistance bands.

17. Resistance bands Stretch the back by using a resistance band wrapped around a stationary pole or column, and leaning back with straight arms

18. Lumbar diagonal rotation Strengthen the abdominals and oblique muscles by performing a diagonal pull with band: with band anchored low to ground, and feet shoulder width apart, grasp band and pull from lower right to left shoulder. Reverse sides.

19. Vigorous Low Impact Conditioning for Rehabilitation Regular aerobic exercise (walking/swimming) will increase blood flow and oxygen. It will also burn excess calories, thus maintaining weight and preventing added stress on the back structures and surgical site.

20. Contraindicated exercises Jogging or running Some forms of dance and aerobics Contact sports such as basketball or football

21. No smoking! Nicotine kills the osteoblasts that grow bone and the postoperative results of patients who go back to smoking are much worse than of those who remain off of nicotine. Smoking even after a solid fusion is achieved has been well correlated to chronic low back pain.

22. Studies on smoking Research has demonstrated that habitual cigarette smoking leads to the breakdown of the spine to such a degree that fusion is often less successful when compared to similar procedures performed on non- smokers A study evaluated tobacco use in patients who underwent lumbar (low back) fusion. The patients who smoked had failed fusions in up to 40% of cases, compared to only 8% among non-smokers. Similar findings have been reported in other studies as well.

23. References http://orthoinfo.aaos.org/topic.cfm?topic=a0 0348 http://www.spine- health.com/wellness/exercise/vigorous-low- impact-conditioning-rehabilitation