Low Back Pain:
Chiropractic Care for the Post-Lumbar Fusion Patient
Between 1993 and 2013, the number of lumbar fusion surgeries for low back pain and related spinal conditions increased significantly from 61,000 per year to 450,000 per year! Unfortunately, up to 61% of patients who undergo back surgery will continue to experience chronic low back pain. Many of these patients will opt for non-surgical care to address their ongoing pain, which may lead them to consult with a doctor of chiropractic.
In fact, a survey of 62 chiropractors in the Veterans Administration healthcare system revealed that nearly 90% treated at least one post-fusion patient in the previous month and two-thirds treated between one to five such patients. Most often, these patients came from a referral from their medical physician, physical therapist, or orthopedic and neurological surgeon.
So, what can the post-fusion patient expect when he or she visits a chiropractor? In addition to taking a patient history and a physical examination, when the post-fusion patient presents for care, the chiropractor will often take x-rays, which may include weight-bearing (standing), neutral AP (front), and lateral (side) views, as well as x-rays taken in full flexion (forward bending) and extension (backward bending) positions. The importance of the x-ray assessment is to evaluate for fusion stability (i.e., fusion failure) and to look for broken screws and other hardware malfunction that may require a referral back to their surgeon. Additionally, the x-rays will allow the doctor of chiropractic to assess the levels above and below the fused segments because it’s common for these joints to become hypermobile, which can lead to injury and pain. Depending on the individual case, a CT and/or MRI may be appropriate as these can offer further diagnostic information such as the presence of spondyloarthopathies, a tumor, infection, intervertebral disk herniation, postoperative scar or fibrosis formation, and more.
Though large-scale, randomized controlled trials to assess the efficacy and safety of chiropractic care for the post-fusion patient have not been completed, there are several case reports and series that have shown that the techniques often used for the general low back pain population are similarly as effective. These include high-velocity, low amplitude manipulation, mobilization, and soft tissue techniques, as well as specific exercises targeted to the core muscle groups and even nutrition instruction. Perhaps most important, in all the papers published to date regarding chiropractic treatment of the post-fusion low back pain patient population, no serious adverse effects have been reported and no patients have required surgical intervention following chiropractic care.