Lumbar Fusion Protocol

PHASE

CONSIDERATIONS

TREATMENTS

GOALS

Phase I

0-6 weeks

1-2 PT visits

Healing and protection

  • Avoid ROM at level of fusion
  • Use rigid brace at MD discretion for 3-6 weeks
  • No lifting > 5 lbs
  • Maintain neutral spine position
  • Teach transverse abdominal recruitment
  • Begin walking 1-2 times per day
  • Relaxation and pain control strategies
  • Neutral spine concept
  • Hip hinge for sitting
  • Home exercises: isometrics(quad, gluts, hams), ankle pumps, seated knee extension, seated ball squeeze, wall squats, scapular retraction
  • Walk up to 1-2 miles, or 30 minutes by 6 weeks
  • Protect fusion by following post op precautions
  • Independent with HEP
  • Understand importance of neutral spine
  • Demonstrate well healing surgical incisions
Phase II

6-12 weeks

PT 2x/week

Basic stabilization and body mechanics

  • Limit overhead reaching for 12 weeks
  • Focus on good posture and body mechanics with daily activities
  • Progress lumbar stabs with UE/LE exercises
  • Progress from fully supported to upright exercises
  • Utilize soft tissue and scar mobilization as needed
  • Pain management techniques as needed
  • Progress walking distance
  • Wean out of brace at MD discretion
  • Soft tissue/ scar mobilization as needed
  • Address any flexibility or mechanical issues
  • Balance and proprioception exercises
  • Modalities as needed
  • Stress neutral spine technique
  • Lumbar stabilization progression to include: wall squats,   dying bug supine march, prone and quadruped exercises, UE tubing
  • Walking 3 miles or 30-40 min by 12 weeks
  • Independent with HEP
  • Good understanding of safe body mechanics with daily activities
  • Single leg balance > 10 seconds
Phase III

12- 18 weeks

1-2x/week as needed

Functional rehabilitation

  • Progress to independent HEP
  • Assess for any remaining postural, strength, flexibility or proprioceptive deficits
  • Advanced lumbar stabilization, unsupported
  • Resistance training
  • Advance cardio exercises to include bike, elliptical
  • Work simulation activities as indicated
  • Independent with HEP
  • Progress to pre surgical activities
  • Return to work

 

Lumbar Fusion: General Considerations

  • Nicotine in any form is a hindrance to bone fusion and healing
  • No anti-inflammatory medication until 3 months post-op, then Mobic until 6 months
  • Avoid range of motion at level of fusion for 3 months and/or radiographic signs of fusion
  • Avoid rotation for at least 4 months
  • Avoid excessive spinal loading or distraction
  • No baths or soaking for 4-6 weeks, until incision sites are fully healed
  • No household chores for 4-6 weeks
  • No yard work for 3 months
  • No lifting greater than 5 lbs for 6 weeks
  • No driving for at least 2 weeks, usual 4-6 weeks but must also evaluate pain med use and functional mobility
  • Avoid sitting for longer than 20 min and use a small pillow to support your back
  • Maintain good standing posture
  • To get up from lying down, roll on to your side, bend your knees and allow your feet to come off of the bed as you sit up.
  • Sleep either on your side with knees bent and a pillow between your knees or on your back with a pillow under your knees.

The following clinical observations require a consultation with the surgeon:

  1. Failure of incision to close or significant redness, swelling or pain in the area of incision.
  2. Unexpectedly high self-reports of pain in comparison to presurgical state.
  3. Loss of Bowel or Bladder function.
  4. Failure to meet progress milestones according to protocol “guidelines” as may be modified by clinical judgment with consideration givento previous presurgical state and typical progression of patients during rehabilitation.
  5. Evidence of acute exacerbation of symptoms: significant increase of pain, sudden increase of radicular symptoms, and/or sudden lossof strength/sensation/ reflexes.
  6. Development of new unexpected symptoms during the course of rehabilitation.