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LUMBAR FUSION PHYSICAL THERAPY POST OP PROTOCOL
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PHASE 1 – 0-4 WEEKS (WOUND HEALING AND PROTECTION – OUTPATIENT PT STARTS AT 2-4 WEEKS)
OBJECTIVES: Pain control, wound care and promote healing via progression of mobility. Resume driving
after 2-4 weeks or when off pain medication. Limit driving to short intervals < 30 min./time.
PRECAUTIONS: Avoid flexion motion and extension/rotation beyond neutral. NO lifting > 15 lbs. and NO
impact activities for 12 weeks. Limit sitting to no longer than 30 min./time. Wear brace as directed if > 2
level fusion or osteoporotic. If prescribed – patient wears bone growth stimulator 6-12 months.
*RADICULAR SYMPTOMS MAY COME AND GO THROUGHOUT RECOVERY. ANY NEW WEAKNESS, SEVERE
PAIN OR GLOBAL NUMBNESS SHOULD BE REPORTED TO SURGEON/PA.*
PHYSICAL THERAPY: EDUCATION
BODY MECHANICS: BED MOBILITY/POSITIONING, LOG ROLLING, TRANSFERS.
POSTURE EDUCATION: SITTING IN NEUTRAL WITH SUPPORT, CHANGING POSITIONS EVERY 30 MIN., AND
HOW TO LIFT < 15 LBS. FOR 12 WEEKS.
DRIVING: ALLOWED WHEN OFF NARCOTIC PAIN MEDICATION AND NO LEG WEAKNESS (2-4 WEEKS).
EXERCISES:
STRETCHING:
SUPINE: Hip flexors, hamstrings, calves.
MAT EXERCISES:
TA BRACING – isometrics
GLUTE SETS – isometrics
TA WITH MARCHIG, HEEL SLIDES, SAQ, SLR, ABDUCTION
STANDING BALANCE:
AIREX – tandem balance, lateral step off, forward step off.
WALKING/RECUMBENT STEPPER – 1-2x/day for up to 10 minutes.
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PHYSICAL THERAPY:
EDUCATION:
BODY MECHANICS: REVIEW ERGONOMICS OF
WORKSTATION (issue guidelines).
POSTURAL EDUCATION: MINIMIZE FORWARD LEAN
AND SWAYBACK POSTURE.
LIMIT FLEXION BELOW KNEE LEVEL AND KNEES
ABOVE HIP HEIGHT. AVOID EXTENSION BEYOND 20
DEGREES (as exercise) AND ROTATION > 25
DEGREES.
EXERCISES:
STRETCHING:
Hip flexors, hamstrings, gastroc/soleus.
BALANCE PROGRESSION:
AIREX – Tandem, double leg, single leg, step
overs, standing shuttle side taps/squats.
BOSU: Sit to stand (hard side), balance either
side.
STRENGTH:
Progression of TA bracing with ball bridge,
double leg/single leg, bird dog, mini squats, step
ups, mini lunge (closed chain to open chain),
side-lying clams, wall pushups, theraband row
and pulldowns etc. Lower extremity knee
extension and hamstring curls.
PHASE 2 – 4-8 WEEKS (START OF FUNCTIONAL STRENGTHENING – UP TO 12 WEEKS TOTAL)
OBJECTIVES: Wean off pain medication to OTC management, begin scar management (when incision
closed), ambulation progression to promote healing, pain free ADL tasks.
PRECAUTIONS: NO lifting > 15 lbs. for 12 weeks. Avoid extension beyond 10 degrees, bending and
twisting (squat). Continue to wear brace (if prescribed) for driving in car – up to 8 weeks (osteoporosis).
FUSION:
WITH VERTEBRAL AUGMENTATION: Involves placement of fenestrated screws with cement pushed into
the vertebral body through the distal portion of the screw. This will appear as dark, cloudy area within
vertebral body on x-ray. Used in osteoporotic/osteopenic patients for increased fixation/better fusion
outcomes.
WITH OSTEOTOMY: Involves removal of a portion of the vertebral body to allow for better correction
of alignment of the spine. Typically seen in cases with fracture of the vertebral body.
WITH ILIAC FIXATION: Extension of the posterior fusion to include the pelvis. Occasionally involves one
additional midline incision at the inferior portion of the construct. Can include 2 iliac “bolts” for true SI joint
fusion.
REVISION PSIF: Involves either removal/replacement of old hardware to include additional levels OR
leaving old hardware and tying in with additional screws/rods (z-rod, domino connectors, etc.) See op note
for details.
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PSIF – ONE MIDLINE INCISION, TWO PARAMEDIAN INCISIONS. DERMABOND CLOSURE.
ALIF – ANTERIOR MIDLINE INCISION (performed with assistance from general surgeon to complete
approach and wound closure). DERMABOND or STAPLE CLOSURE. (Staples removed 10-14 days
post-op.)
LLIF – LATERAL INCISION (left or right flank). May have multiple lateral incisions depending on number of
levels. DERMABOND CLOSURE.
TLIF – POSTERIOR MIDLINE INCISION WITH TWO “STAB WOUNDS”. (Usually combined with PSIF for
fixation of surgical levels, typically with robotic navigation. DERMABOND CLOSURE MIDLINE – “STAB
WOUNDS” CLOSED WITH NYLON SUTURES (removed at 2-week post-op check). Drainage common,
reinforce with pressure dressing and monitor for signs of infection.
SURGICAL SITE: OK TO GET WET – DO NOT SUBMERGE
DO NOT APPLY LOTIONS/BALMS/OINTMENTS TO SURGICAL SITE.
