Brian T. Swanson
© 2016 Anna Sidloski
Background and Purpose: Lumbar spinal fusion surgery has been utilized to manage levels of low back pain and instability. However, pain often persists post-operatively. Evidence supports the use of Transverse Abdominis recruitment in patients with LBP. Research demonstrates strengthening the hip musculature may allow for improved outcomes for those who experience LBP. There is limited research focusing on lower extremity strengthening, flexibility, and balance training in a patient following a T11-L5 spinal fusion. Case Description: The patient was a 68-year-old male presenting to physical therapy eight weeks’ status post T11-L5 spinal fusion with ~45 degrees forward-flexed posture, weak lower extremity musculature, and restricted muscle lengths. Post operatively, the patient smoked and did not engage in exercise prior to surgery. Interventions consisted of TA recruitment, lower extremity/glute strengthening, stretching, and balance training. Outcome measures included Numeric Pain Rating Scale (NPRS), Oswestry Disability Index (ODI), Dynamic Gait Index (DGI), and Berg Balance Scale (BBS). Outcomes: Results from initial evaluation to discharge: ODI 54% to 36%, NPRS 3-8/10 to 0-5/10, DGI 16/24 to 16/24, and BBS 43/54 to 43/56, demonstrating improved function and decreased pain, but similar balance scores. Discussion: These interventions may be beneficial in improving functional strength and posture s/p spinal fusion. Cigarette smoking and lack of previous exercise may have contributed to lack of large improvements in balance and MMT, and inability for the patient to return to work. Further research is needed to report upon the outcomes of this approach in managing individuals with LBP after spinal fusion surgery.
Sidloski, Anna, "Use Of Functional Strengthening, Balance Training, And Stretching In The Treatment Of A Patient Following A T11-L5 Spinal Fusion: A Case Report" (2016). Case Report Papers. 58.