The resurgence of Tiger Woods’ golf performance has produced questions on the merits of spinal fusion surgery. Fitness clients and physical therapy patients have heard that Mr. Woods had his lower lumbar vertebrae surgically fused and is now doing well. Recent articles in the *New York Times and **Wall Street Journal illuminate the good and bad of spinal fusion surgery and the changes it produced in Tigers’ golf game. Spinal fusion patients are frequent costumers in the physical therapy clinic. Based on my long history treating post fusion patients, these are the answers I give in regards to spinal fusion surgery.
Can You Do Your Part?
Anyone considering lumbar spinal fusion needs to be ready to make a commitment to developing an exercise habit. The routines are easy and short–ten to twenty minutes. It has to be often–daily is imperative. It has to be forever. All long-term studies on spinal fusion outcomes have revealed optimal results with consistent exercise participation. Formal rehab should last six weeks. Your ongoing routine needs to be spinal specific and ideally it will be monitored and progressed under the supervision of a physical therapist trained in spinal care. If you know you lack the capacity to stay consistent with a training program, do not have a lumbar fusion.
Don’t Get Fat
Overweight patients do not do well with spinal fusion surgery. They often graduate to become repeat spinal surgery patients. Keep your weight under control. The best assessment tool is the tape measure. A waist that is one half your height places less stress on a post-surgical spine.
Smokers have a much higher incidence of fusion failure than non-smokers. The blood flow restriction create by smoking inhibits bone healing. Quit the habit well before undergoing any spinal surgery.
Did Active Rehab Fail to Improve Your Function and/or Pain?
Recovery from a lumbar spine pain problem takes time and effort. Did you perform an active program for at least six months? Heat treatments, electrical stimulus, acupuncture, massage, and ultrasound are all passive treatments that do not enhance spinal function or improve pain outcomes. Your back recovery program should look like this:
Prescribed spinal exercise routine–once or twice a day.
Daily walking program.
Dietary changes for better body composition.
Active rehab programs work for the vast majority of lumbar spine patients. It is just hard to get people to do it.
Are You Aware of the Need to Alter Your Lifestyle?
After a lumbar fusion, you will have one less spinal shock absorber and less spinal movement. The fusion has been performed to stabilize your spine, reduce pain, and permit basic movement–walking, transfers, and stairs. After a spinal fusion, you must be willing to make accommodations for the mechanical alterations in your spine. You may love to sit on the tractor for hours, but your post-surgical spine does not. You may say that chopping wood is “What I do”, but your post-surgical lumbar spine says something else. Emotionally, you feel better when you lift the grandchild, but physically you will pay a price. Many people return to physical therapy and surgery because they are unwilling to change behavior.
Spinal fusion has its place in the treatment of lumbar pain problems. Potential surgical patients need to be aware of the ongoing effort it takes to produce a good outcome. Tiger Woods is a fit, normal bodyweight, non-smoker who is very motivated to do everything in his power to improve. If you align with all of those parameters, your lumbar fusion will probably go well.
Michael O’Hara PT, OCS, CSCS