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34 m a s s a g e & b o d y wo r k m a rc h /a p r i l 2 0 2 1 Spinal Fusion Surgery Common, Complicated, Controversial By Ruth Werner education | PATHOLOGY PERSPECTIVES In the fall of 2020, I recorded an I Have a Client Who . . . podcast about a massage therapist whose client had spinal fusion surgery, along with some other health challenges. In pulling together information for that project, I found lots and lots of material about spinal fusions—and almost nothing about massage therapy for these patients. This surprised me because spinal fusions and similar surgeries are among the most common operations conducted in the United States. Also, as evidenced by the person who contributed the story to my podcast, it is a sure bet that many massage therapists have clients who have been through this process. But what do we know about the procedure and where massage therapy fits in this context? DEFINITION Spinal fusion surgery is a procedure that joins connecting vertebrae by fusing them together. According to the American Academy of Orthopedic Surgeons, "It is essentially a 'welding' process. The basic idea is to fuse together two or more vertebrae so that they heal into a single, solid bone. This is done to eliminate painful motion or to restore stability in the spine." 1 So, spinal fusion surgery is recommended when a surgeon believes too much movement between vertebrae leads to severe pain that cannot be managed any other way. Read that carefully: too much movement between vertebrae leads to severe pain. This is a surprisingly complicated concept, given what we know (and don't know) about how the spine works, and how pain is generated. It is an assumption that turns out to be true in many—but not all—cases. SPINAL FUSION SURGERY STATISTICS It's difficult to gather statistics on exactly how many spinal fusion surgeries are conducted, but an organization that tracks device sales suggests that about 352,000 interbody fusions are conducted each year. However, this does not account for all cervical fixations or disk replacement surgeries and other spine- stabilizing procedures. Also, a person may have multiple fusions in a single surgery, which further muddies the numbers. What we do know is that in the United States we spend over $6 billion per year on spinal implant devices. 2 The number of surgeries conducted in this country has risen substantially in the last two decades. This is partly because a large number of baby boomers are now candidates for this procedure, and also because new technologies have reduced many of the risks associated with fusions. Spinal fusion surgery is considered a more feasible option than living with chronic, intractable pain that does not respond to less invasive treatments. WHO NEEDS SPINAL FUSION SURGERY? Obviously, with a surgery as common, complex, and fraught with possible complications as spinal fusion therapy, you would think we must have a well-established rubric for when, why, and for whom these surgeries should take place. You'd be wrong. The reasons spinal fusion surgery is often controversial are fascinating but not central to this discussion. Still, I couldn't resist exploring this topic a bit, and I will share what I learned, along with an interview with massage therapist, past Massage & Bodywork columnist, and spinal fusion surgery veteran Diana Thompson in the video that accompanies this article. When considering spinal fusion surgery, the decision-making process theoretically involves trying to quantify a person's spinal instability, and we don't have a great way to do that. In addition, surgeons must try to analyze the multiple contributors to pain responses in order to predict whether surgery is likely to improve the situation, and this is not always clear.

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