Article Rundown

• Why spinal fusions can fail
• Bad physical therapy
• Not listening to your doctor
• Back directions given by the doctor

Why Do Spinal Fusions FAIL?

In this video, I discuss spinal fusions and the reasons why they sometimes fail. There are numerous factors that can contribute to the failure of a spinal fusion. The first reason could be that the surgery itself is not appropriate for the patient. For example, in the case of an unstable spondylolisthesis, a spinal fusion may be necessary and can be life-changing. However, it is crucial that the surgery aligns with the patient’s specific condition. Someone with a case of spondylolisthesis, where the pars is damaged and a segment can slip forward and/or become unstable, potentially trapping nerve roots, may benefit from a fusion.

However, issues can arise if the fusion is performed at the wrong level of the spine, or if an incorrect type of fusion is chosen. In some cases, only one level may be fused when multiple levels are needed, thus addressing only part of the problem. Additionally, issues such as improper screw placement or the wrong type of cage can also hinder the success of the surgery. There are numerous factors that can affect the outcome of this procedure, either contributing to its success or worsening the patient’s condition.

Cookie-Cutter Physical Therapy

A second issue that may arise is that, even when the right surgery is performed successfully, the post-surgery rehabilitation may be inadequate. Often, physical therapists use generic rehabilitation programs that do not address the specific pain generators or causes of the patient’s injury. This can result in the recurrence of pain or, in some cases, an even worse condition. If you would like to learn more about common physical therapy issues, I made a video on the topic, which you can find [HERE]. For instance, end-range flexion and extension exercises for a spondylitic fracture are not suitable during recovery. In some cases, if a patient had received a proper assessment and targeted treatment before the surgery, they might have avoided the need for surgery altogether. Additionally, relying on chiropractors who only perform spinal adjustments without reviewing imaging or providing a thorough assessment can worsen the patient’s condition. For more information on that, you can watch a video I made [HERE].

I recently had a friend undergo spinal fusion surgery, and he mentioned that his pain returned soon after. The first question I asked him was, “What exercises did your physical therapist recommend?” He explained that the therapist instructed him to bend forward, touch his toes, perform extension exercises, and twist his spine—all in an attempt to regain range of motion. This was just a couple of weeks after surgery. This approach is one of the worst things you can do to the spine so soon after a fusion or any back surgery. Essentially, the physical therapist was causing the injury to reoccur after the patient had spent thousands of dollars on surgery, only to return to pain due to improper rehabilitation. It is important to note that it can take years for a spinal fusion to fully heal and stabilize. As such, careful consideration must be given when selecting a physical therapist post-surgery.

Not Listening to the Doctor Correctly

Another reason why spinal fusion surgeries may fail is that the patient does not adhere to their doctor’s advice and returns to the activities that caused the injury in the first place, without allowing adequate recovery time. Engaging in physically demanding activities too soon can delay the fusion process, which may take up to a year or longer. This can ultimately result in the need for additional surgeries down the line. It is essential to rebuild your body’s capacity gradually, using the right exercises and stimuli. Learning proper spine hygiene and avoiding the movements that led to the surgery in the first place is crucial for long-term recovery. Some patients may feel pain-free or assume they have recovered, but they may still be relying on pain medication that masks their symptoms. This can lead them to prematurely return to high-impact activities such as heavy lifting, pickleball, or golf, which can cause the pain to resurface—sometimes even worse than before—because of the surgical hardware now placed in their spine.

Bad Direction Given by the Doctor

Another reason for failure can be insufficient or poor post-surgery instructions from the doctor. Some patients I see after spinal fusion surgeries were told that once their incision had healed, they could resume their normal activities as long as they “ease into it”—but this vague advice is often insufficient. These patients often find themselves needing multiple fusion surgeries, which could have been avoided with better guidance in the first place. Each subsequent surgery becomes more difficult, and the success rate can decrease. I have also heard physical therapists dismiss their patients’ pain, suggesting that it is “all in their head,” which is an inadequate response to the patient’s condition. This highlights the importance of a thorough assessment by professionals like myself, both before and after surgery. Understanding the specifics of your injury, what causes your pain, and what provides relief allows us to create a personalized program that will help you recover on an appropriate timeline, minimizing the risk of needing additional surgeries. If this is something you are interested in, you can learn more [HERE].

Conclusion 

Spinal fusion surgery can be a life-changing procedure when performed for the right reasons, but its success depends on many factors. From selecting the correct surgical approach and ensuring appropriate post-surgical physical therapy, to following recovery protocols and avoiding reinjury, a well-rounded, individualized plan is crucial for achieving long-term success. If any one of these elements is overlooked, it can lead to complications or even failure of the surgery. It is important for patients to work closely with their medical team, adhere to recovery guidelines, and seek professional guidance to ensure the best possible outcome. By doing so, they can improve their chances of a successful recovery and avoid the need for repeated surgeries.

BRIAN DOES ONLINE AND IN-PERSON COACHING!

Back Injured Average Mary or Joe who wants their life back

Back Injured Athlete Wanting to Return to Sport

Lift and exercise coaching & cueing to troubleshoot form

Program adherence & accountability coaching