Non-surgical alternatives to spinal fusion focus on building up intrinsic muscle power of the spine. Spinal fusion is (or should) only performed where a vertebra has become loose in the spinal chain and slips forward whenever the spine bends (this is known as segmental instability). The sole purpose of the muscle strengthening is to overcome the acquired osseo-ligamentous laxity and use muscle-power to knit the loose segment in neatly with the rest of the spine. However, this is a delicate process that always takes time. It's always a two steps forward one step back job that cannot be hurried. If you have true instability (though bear in mind it is often diagnosed willy-nilly) the problem spinal segment will be inflamed and easily annoyed by targeting the local muscles around it - meaning it will react badly to stampeding tactics. Spinal intrinsic strengthening must always be taken slowly.
Spinal fusion is often performed inappropriately - simply for pain reduction. And it is rarely effective in doing this. Fusion may also be performed as the second part of a procedure following surgery to remove an intervertebral disc. The operation involves joining one spinal segment to its neighbours through the use of large titanium screws. Fusions should never be done to reduce pain. The ONLY indications for this procedure is instability of a spinal segment. Segmental instability is uncommon (it is the end stage of the breakdown of a spinal segment see Back Sufferers Bible Chapter 6 ) although the good news is that very few spines deteriorate to this degree.
A dehydrated flaccid disc combined with weakening of the bony facet joint 'catch' causes instability
Instability of a spinal segment can happen traumatically with breakage or stretching of the bony lock (spondylolysis) 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 this video here.
Multifidus is the bending muscle
Spinal fusion should only be considered as a last resort for stabilising an uncontrolled spinal segment. The critically important guiding principle as an alternative to spinal fusion is restoring power - and control - to the deep spinal muscle 'multifidus'. This will help compensate for weakness of the disc and laxity of the facet joints at the problem spinal level, while also improving co-ordination of the spinal muscles.
The role of muscles multifidus is specifically to control bending movement of the spinal segments. Hand in glove with strengthening multifidus should be strengthening the abdominal muscles to help prevent forward shear of the lumbar segments as a stack bends forward. Both groups help control instability and help stay the day on surgical spinal fusion.
Grade 1 consists of lying on your back and languidly waggling your bottom. the movement should be small and effortless as a snake-like undulation through your spine, which also creates a left-to-right movement of the hips. it should be continued for 60 seconds. Then sit yourself up (pulling your tummy in and carefully rolling up if you are wary) and do a similar action in the sitting position. This 'one-minute morning ritual' should be repeated throughout the day before you go to stand up from sitting (often the most taxing effort if you have true instability).
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.
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 (try to see this as an agreeable feeling!) 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.
Straighten to vertical as an unfurling action by tightening the butt 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.
Unfurl to horizontal with the same butt contraction, pulling in the tummy hard. Repeat 7-10 times only.
Through the process of moving and making the body do formal strengthening, the same exercising alternatives to spinal fusion also restore proper, natural 'neural messaging' so that the right muscles switch on happily and work at the right time. This is important, as often through fear avoidance and faithfully following instructions not to bend, backs become increasingly more brittle - and 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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