Any type of spinal surgery is a serious matter. For this reason, it's imperative to explore all non-surgical alternatives to spinal fusion before taking the plunge.
Spinal fusion is often performed inappropriately. It involves joining one spinal segment to its neighbours through the use of large titanium screws. The specific indications for doing this is instability or looseness of a spinal segment. Sarah Key's hypothesis of the '5 stages of spinal breakdown' puts segmental instability as the end stage. As she explains, not many spines deteriorate to this degree, however those that do are more complicated and more difficult to reverse.
A weakened flaccid disc can cause instability,
or weakening of the bony facet joint lock
Instability of a spinal segment can happen because by breakage or weakness of the bony lock of the facet joints that hook the segments together, or it can be caused by the gradual weakening of the disc, usually after disc prolapse. You can read more about instability of a spinal segment here.
In this extremely important video, you can watch Sarah explaining the different causes of our weak back for which spinal surgery has been suggested.
Read more about it here.
Spinal fusion should only be considered as a last resort for stabilising an uncontrolled spinal segment. If you want to avoid spinal surgery, the most important principle in the non-surgical alternatives to back fusion is restoring power - and control - to certain muscles. This will compensate for weakness of the disc and laxity of the facet joints at the problem spinal level, while it also improves the co-ordination of the spinal muscles.
The sole aim of the non-surgical alternatives to back fusion is isolating and strengthening the deep spinal muscles whose job it is to control individual movement of the spinal segments. To a lesser degree ~ but still very important ~ is strengthening the abdominal muscles to help prevent forward shear of the lumbar segments leaning over as a stack as the spine bends forward. Both groups help control instability and help stay the day on surgical spinal fusion.
Grade 1 consists of lying prone, pillow supporting the abdomen and languidly waggling the bottom. The movement should be small and effortless as a rotatory left to right movement of the hips, in almost a hip-shaking action. It should be continued for 60 seconds.
Grade 2 is segmental pelvic bridging, starting from lying on the back on the floor, knees bent. By tipping the pelvis back to lift the bottom, you roll up the spine, cog by cog, until you are are straight bridge with a straight line between shoulders, hips and knees.
Though not shown here, the action of lifting the bottom is a 'peeling-up movement' where you lift up the spine from the floor cog by cog
Grade 3 consists of bending over from the standing position and unfurling cog by cog back to vertical. If you feel unsafe bending forward to start with you can 'walk down your legs' until you are fully bent forward and hanging, as relaxed as possible, neck dangling. After letting the spine pull out momentarily, you then contract your buttocks and pull in your lower abdomen in unison to roll your pelvis back as you unfurl segment by segment up to vertical. As this is a very strenuous exercise, only repeat it a couple of times, twice a day only. Any more and the back will be very sore.
As you straighten up to vertical, make it an unfurling action, initiated by tightening the bottom and pulling in the tummy, head coming up last
Grade 4 needs help to hold your legs down from a starting position off the end of a plinth or table. Starting from a position of arms crossed on your chest you unfurl cog by cog up to horizontal with the same, exacting, unfurling action, the head coming up last. Make sure you do not hyper-extend beyond the horizontal and repeat each unfurling action up to 12 times. Do not repeat the exercise more frequently than once every 7 to 10 days.
Unfurling to horizontal with the same buttocks pinching and pulling in the tummy action is very strenuous. Repeat up to 12 times only.
Through the process of moving and making the body do formal strengthening, the same exercises also restore proper, natural 'neural messaging' so that the right muscles work at the right time. This is important, as often through fear avoidance and faithfully following instructions not to bend, backs become increasingly more unstable as the deep intrinsic muscles, and the supporting abdominal muscles, switch off. The incorrect messaging and resulting abnormal movement patterns lead to further weakness and loss of control - and this is how instability of the problem segment gets worse.
For specific treatment protocols for both acute and chronic instability you can follow 'Typical Self Treatment for Acute/Chronic Instability' in The Back Sufferers' Bible. (See below for purchase options)
Anybody considering spinal surgery should read the Ebook 'Be Careful about Back Surgery'
Osteophytes are bony outgrowths from the margins of the vertebrae.
They are Nature's way of stabilizing a weak link
The natural history of an unstable segment in the longer term is 'ankylosis' or natural fusion of the loose segment through extra bone formation, known as osteophytes. The body responds, in its inimitable way, by manufacturing more bone both at the disc-vertebra junction (bony spurs) and at the facet joints ('wrap around bumpers'). Often, during back fusion surgery these bony outgrowths are removed, thus making it harder to attain success with the surgical procedure.
There is rarely, if ever, any plausible indication for the surgical removal of osteophytes or bony spurs Nor is there any credibility in the oft repeated suggestion that the bone is piercing nearby nerve and responsible for the pain. Osteophytes are Nature's way of making the spine more secure and less painful.
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