Fusion surgery is not an end. It’s a beginning. It’s a beginning of a healing process, and that healing process will probably take you to Dr. Sean Riley at Tulsa Spine and Rehab. Dr. Riley, I know you’ve had a quite a bit of experience with post-fusion therapy.
Transcript:
Yeah. I was treating a good friend of mine, a guy that I grew up with, played a bit of soccer with, and comes in with neck pain, radiating pain down to his right shoulder, inside of his shoulder blade. We’re a conservative spots so we’re obviously going to do what needs to be done conservatively. He wasn’t responding appropriately in my opinion. Something that we’ve always talked about here at Tulsa Spine and Rehab, if you are not responding, the appropriate amount of time, we’re going to get you to the right person. Sent him out for an MRI, and unfortunately he had a somewhat significant disc herniation in his cervical or his neck region. I think actually the radiologist called it a “massive disc herniation”, so I knew that I was somewhat limited what we could do on the front end with him.
Referred him to a neurosurgeon here in town, and I knew. The surgeon called me back and said, “Sean, we’re going to do a discectomy with fusion.” What they do, Charlie, is many times with these large fusions, it can put pressure on a nerve root or potentially on the spinal cord itself. What they do is they actually, typically with the neck, they’ll go through the front. They will surgically remove the disc, okay, between the two vertebra. Sometimes put some form of a spacer in there and then use hardware, or some time a graft from the hip to fuse those two levels together. Essentially what we’ve done is, we’ve removed the disc and fused two bones together. Many times that resolves the current complaints, hopefully. He had marked radiating pain into his arm with a little bit of weakness. When you develop that much pressure on the cord and the nerves, you can develop those types of symptoms.
Unfortunately what happens … You can imagine mechanically if you had taken an area that moves relatively easily, and you just essentially take the movement out of it with hardware, you could have problems down the line. Obviously I believe in surgery. I mean sometimes we’re going to need it, but I always talk to patients to try to jump through as many conservative hoops as you can. But in this case, he needed to have that surgery. He didn’t have any options. So many times on intake information here in the clinic, Charlie, I see a history of lumbar fusion or some form of cervical fusion, and patients will continue with some form of neck or back pain. Many times however it’s changed. Meaning the arm or leg involvement has resolved itself or is much better, but they might be experiencing just ongoing low-back pain, neck pain, whatever the case may be.
What are the options when you get into that point, Sean?
Yeah. First off, I want to encourage patients, let them know that, “Hey. There are some things that we can do to provide relief.” Once again, going back to an examination, proper diagnosis, and making sure that conservative treatment is an option for them. For example, chiropractic therapy. Obviously with any type of a fusion where you mechanically fuse a site with hardware, I’m not going to move it around with my hands. That’s the last thing that we want to be doing. However, I am going to be paying very close attention to the area above and below the fusion site. Charlie, imagine I had an area of your spine that moved relatively well, and then we limit or take the motion out of that area, what’s going to happen above and below? It’s likely going to move more. Right? I mean does that make sense?
Sure. Sure. It’s going to offset the lack of motion in the other areas.
Right. So that’s one of the things that we really need to watch out for in these fusion cases is that they have the potential to develop problems above and below the fusion site. For instance, the neck. Okay? We talked about a neck fusion. Let’s say it’s C5, C6. That’s an area very low in the neck. One is up high by the base of your skull, and 7 is down there kind of towards your upper back. In these 5, 6 fusion cases, I’m really going pay attention to the mid-thoracic spine area. That is the area below the neck, kind of between your shoulder blades. I want to make sure that area has proper mechanics, proper function, proper movement. Are we stable above the fusion site? There can be, if indicated, a little bit of chiropractic therapy involved in these types of cases. Obviously stabilization, home exercise.
I work with a handful of neurosurgeons here in town, and I see a lot of their post-lumbar fusion patients. Those are the patients that have been fused in the lumbar. What we’ve experienced here in the clinic is the SI joint or sacroiliac, those are the joints there kind of on your pelvis. Mobilizing and maintaining those SI joints have been a good treatment option for those lumbar fusion patients. So that is something that we’re able to do for the low back patient. Clinical massage therapy, have they started getting a little tight or overactive in the hip flexor, or maybe another muscle group? I think manually there’s some things that we could do. Laser therapy. We’ve added high-intensity laser therapy to the clinic. A fantastic non-surgical tool to reduce inflammation, because many times post-surgically other areas are working maybe a little bit harder and chronically inflamed. So hat’s a fantastic tool to reduce inflammation and pain as well.
With all that said, it almost feels like fusion surgery is something to be avoided.
Well, sometimes you don’t have a choice. Years and years ago a good surgeon friend of mine said, “You know, Sean, a good surgeon knows when to cut. A great surgeon knows when not to cut.” I think there’s a lot of value in that little saying that … Like my friend that I’d spoke about earlier. I mean he didn’t have a choice, and so I think it’s reasonable too is, if you feel like you want to get a second opinion. But once you get that disc putting pressure on a nerve or a spinal cord, and it’s resulted in neurological complaints, Charlie, whether it’s weakness, pain, maybe reflexes are a little diminished, we’re at a critical stage there that we might need to be doing something.
To speak to that, MRI will typically let us know the involvement or the severity of a disc. Okay? Typically, the examination might lead us down that path, but ultimately MRI is going to let us know what needs to happen. Many surgeons will say, “Hey listen. Let’s try to manage this conservatively. Let’s try physical therapy. Let’s try some home exercises, and different things.” Other times we just don’t have a choice. Like I said, it all goes back to diagnosis, and being in the appropriate spot, and having the appropriate recommendations made. Just because you have arm pain doesn’t necessarily mean you have a disc herniation. You could have just a little bit of an irritation of a nerve root.
But I think it goes back to that proper diagnosis. Remember, if fusion surgery is indicated and required, there are some options. I mean my buddy, I keep going back to him, he’s playing golf again, and he’s playing soccer, and so he’s very active. I mean this guy is a 47-year-old male, with the radiologist called it a “massive disc herniation”, and he’s back to doing some of those things that he enjoyed prior to surgery. I think obviously that his margin for error, he knows that he’s had a surgery done there, and he needs to watch out for certain types of things, but there are options moving forward for treating different types of things that might pop up.
Summing it up, if you’ve had fusion surgery and you’re still having pain, then Dr. Riley has some solutions for you. Good idea to get in touch with him sooner rather than later. Dr. Riley, thanks for your time today.
Thanks, Charlie.
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