- [Singers] Bob and Brad, the two most famous
Physical Therapists on the internet.
- Hi folks, I'm Bob Schrupp, Physical Therapist.
- Brad Heineck, Physical Therapist.
- Together we are the most famous
physical therapists on the internet.
- In our opinion, of course, Bob.
- Today we're going to talk about the problem
with fusing your spine,
and we're talking about your back or your neck.
And let me first start off by saying, Brad,
there are times that you really have no choice.
- Right.
- You have to undergo surgery,
you have to have your spine fused, neck or your back,
but you should be aware that there's
a common problem that occurs after that.
And, by the way, if you're new to our channel,
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- Right, it'll get into that back
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- There you go, fusion.
- So once again, Brad, if you're having,
and my mom fell into this category.
If you're having what they call intractable pain,
you just can't manage it even with narcotics,
and that's where she was as,
if you're developing weakness
because maybe there's a pinching of the nerve
or a herniated disc, and you've tried
all conservative measures, you may have to have a fusion.
But you have to understand whenever
you have to have your back fused, and we've kind of tried,
this is pretty crude isn't it, Brad?
- Well it is crude, but as we're talking, you know,
sometimes the simplest way to demonstrate gives the best
memorable understanding that a person can have.
- So we're showing here a fusion, basically.
So this is the spine, the head would be right here,
you'd be facing this way, and we got a bunch of the,
now you'll normally get a lot of movement here,
we fused three segments here, right.
- Three vertebra fused together.
- We fused it with duct tape,
which I don't think your surgeon's going to do.
They're going to probably use rods
or something along the lines,
- Yeah, they know what they're doing.
- Some hardware.
So what happens is it's pretty easy to understand here,
if I fuse this area here, and you're going to still
do your everyday living, everyday movement,
everyday lifting, and the movement
has to come from somewhere.
- Right.
- Now if you don't have a back problem
it's being spread out among all the vertebrae.
But if you got a fusion, now the ones above
and the ones below...
- Here, can you move your hand, Bob?
- Yep, are going to do double duty.
- So here and here.
These are locked, so when you bend forward
that's solid, and watch happens,
I'm going to exaggerate this a little bit,
but see how that particular joint,
that vertebra joint...
- Is taking more stress.
- Right, or the one below it.
So what do we call that, Bob?
- Adjacent segment degeneration.
So adjacent means next to it,
the segment means the part of it,
and degeneration means just it's wearing out.
- Right.
- Now in all honesty we really don't know
if that wearing out would've happened anyway,
you know, because it happened in the first place.
- Sure.
- So, but it seems to me like
it would probably accelerate this.
- Right.
- I mean, it just makes sense to me.
And, you know, so I think one of the questions
people are going to have is,
what is the likelihood of this wearing out
and you actually having to have another surgery.
- So then they fuse that joint above it that's wore out.
- Yeah, they'll fuse even more joints.
And one thing just to say on the outset here is
generally the more joints you have fused,
the more likelihood that you're going to get
this adjacent segment degeneration.
- Sure.
- And that makes sense to me, too.
So my mom had surgery, back surgery,
quite a few years ago, ten years ago or so,
and she had intractable pain.
It was awful.
She was getting weakness.
She still has some of that weakness,
residual weakness from that,
so we went ahead with the surgery, she had the surgery.
Three to four years later, yes, she had a revision.
- So they fused another joint above or below it.
- Yep, and she's doing fine now, to be honest,
but I mean it was very
traumatic to go through two surgeries at her age.
- Right, sure.
- You know, I mean it's not an easy thing for anybody,
but for an elderly person.
So I did see one study, we're going to
put the link below, Liz, right?
So it had 73 patients, and they underwent lumbar fusion,
so fusion of the low back.
After fives years, seven of those 73 had to have a revision.
- Just like your mother did.
- Yep, 9.6%.
After 10 years, 11 more people,
so a total of 18 now, had a revision.
- Okay.
- And that's 24%, 24.6%.
- Sure.
- And finally, after 15 years there was six more,
so in total there was 24 people that had a,
24 out of 73 had a revision.
- Okay.
- That's 37.5%.
That's the number I saw a lot, Brad.
I saw 40%, a lot, of revisions
that occurred after initial surgery.
- Right, so and, again, so this was after 15 years.
Almost 40% of people had to go back
and have another surgery.
So you can ask your surgeon what percentage,
from their information or their experience,
and get some feedback, and this is one of those things
if you don't feel comfortable with it,
get a second opinion from another surgeon.
It can really, you know, may be helpful.
- Yeah, I think it's a good question for the surgeon.
I mean, are they, do they tend to be higher than the 40%
or are they lower than the 40%?
I would also definitely ask,
are there any conservative measures I can try first?
Maybe they're going to try an injection,
maybe they're going to try physical therapy.
You know, you definitely want to make sure
you're ruling all of that out.
And the third question that's really important is,
can the surgery be performed with outer fusion?
I mean, can he go in, maybe, you know what I mean?
They can do some things without fusing the back
and relieve the pressure off the disc, or...
- Right, so for example, if this nerve is being pinched
because there's a problem there and they want to fuse it,
well maybe you could just...
- You could do a laminectomy.
- Just a laminectomy.
Open up the foramen, or the hole where the nerve comes out.
- Like a roto-rooter almost, right?
- Well (laughs)
- Yeah, I mean...
- Yeah, a surgeon would love to hear that.
But, yeah, they just go in, and it's very commonly done,
and then just free up the nerve without the fusion,
and you said you know someone who had just that, right?
- Right, right, my brother-in-law actually
fought with his insurance company for years
to make sure that he was going to have,
it was more of a disc replacement type surgery, I think.
Anyway, instead of a fusion, and he had that done,
and he's had really good luck with.
- So they went in, they freed up the nerve
without fusing, and he's doing much better.
- Of course it's a case of one,
so we're not going to give it too much weight.
- Yeah, we don't, can't say that.
- Anyway, we're not trying, again,
trying to discourage you, I just think
it's one of those things you really want
to go in with your eyes wide open.
And loaded with information,
you make better decisions, right?
- Right, and don't be afraid to ask your doctor questions.
They should take the time.
This is your body, it's your spine.
- Write them down, this is a major thing.
Thanks, everybody, for watching.