Frequently asked question: can SI joint dysfunction be caused by lumbar fusion surgery?

Hi everyone!

I’ve noticed that the subject of lumbar fusions has come up pretty often in my emails from readers recently.  It seems like a lot of people are wondering if their SI joint dysfunction could be related to the fact that they’ve had lumbar fusion surgery.

My answer has always been yes… it’s certainly possible.

However, I thought those of you wondering about this might appreciate this video I just found, where an SI joint surgeon actually says the same thing.

Now, let me back up for a second… what is lumbar fusion surgery?

According to the Mayo Clinic,

“Spinal fusion is surgery to permanently connect two or more vertebrae in your spine, eliminating motion between them.

Spinal fusion involves techniques designed to mimic the normal healing process of broken bones. During spinal fusion, your surgeon places bone or a bonelike material within the space between two spinal vertebrae. Metal plates, screws and rods may be used to hold the vertebrae together, so they can heal into one solid unit.”

Spinal fusion means that two vertebrae which previously moved independently in relation to each other are now connected, and only move as one unit.

There are certain reasons why a surgery like this may be necessary.  It might be the only way to heal if you’ve broken a vertebra, and your spine is unstable.   A doctor might also recommend it if you have certain spinal deformities, or degenerative conditions.

However, there are drawbacks.  As the Mayo Clinic website says,

Because spinal fusion surgery immobilizes parts of your spine, it changes the way your spine can move. This places additional stress and strain on the vertebrae above and below the fused portion, and may increase the rate at which those areas of your spine degenerate.” 

Essentially, although lumbar fusion might be necessary to heal one part of your spine, losing motion in that one area can have a negative impact on surrounding areas.

The lumbar spine

Just to be clear, when we talk about a “lumbar fusion,” we’re talking about a spinal fusion in the lumbar area of the spine, which is the lower back.  In other words, the part of the spine that’s closest to the SI joints.

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The lumbar spine

Lumbar fusions and the SI joints

In this video, Dr. Carlton Reckling, an orthopedic surgeon based in Colorado, explains the anatomy of the SI joint, and how it can become injured.

There’s a lot of useful info to unpack from this video, but for the purposes of this post, Dr. Reckling talks about lumbar fusions at the 2:10 mark.

Apparently they’re actually a well-known cause of SI joint dysfunction:

As Dr. Reckling explains, the technical term for this is adjacent segment degeneration.  Basically, with at least two of the lumbar vertebrae fused, the spine isn’t able to move in the way it was intended to.  This places increased stress on the SI joints.

As you may remember from my last posts, the SI joints play a very important role in absorbing some of the forces that travel through our body, and allowing us to move efficiently.

If the lumbar spine stops moving properly, you can bet the SI joints are going to start trying to pick up the slack.  One or both of them will likely become hypermobile in an effort to make up for the motion that the spine has lost.

When an SI joint is hypermobile, that means the ilium and the sacrum are moving more, in relation to each other, than they were meant to.  This can sprain the SI joint ligaments, which means they get a little bit stretched out.  It can also cause inflammation in the joint, as the joint surfaces are rubbing against each other in a way they weren’t meant to.

So… how would I treat this as a physical therapist?

Of course, no one is only looking to hear that their SI joint dysfunction was caused by their lumbar fusion.  They want to know if there’s a way to end their pain.

So…. I am ever an optimist.  If I was your PT, although we obviously couldn’t reverse your lumbar fusion, I would certainly hope there are things we could do to get you out of pain.

First, I would recommend that you ask your doctor about two things:

These are two things that might be able to help you reduce pain right away.  Lidocaine patches are patches with numbing cream that you can put directly over your SI joints (or lumbar spine) for 12 hours at a time.  The pain relief does not reach super deep into your body, but since the SI joints are so close to the surface of the body, I think they can help.

E-stim uses electrial current to stimulate your body’s own natural pain-reducing chemicals.  You can get (either through inurance or out of pocket) a machine to use on your own at home.  I will be honest with you that personally I have not had tons of luck with E-stim (or TENS units) but I know people that have.

Long term:

img_7208-1

My gym pool

If you were my patient (or friend, or family member) I would strongly suggest you look into aquatic physical therapy.  You would, of course, need to find the right place, where you could go at your own speed, and stay in the shallow end if need be.

But I would hope that, although we can’t reverse your lumbar fusion, there would still be a lot of benefit to strengthening your muscles.

Basically, when the muscles around the SI joint are strong, it is much better able to withstand wear and tear.  

I have personally found that not only can my muscles hold my joint in place better when they’re strong…. it’s almost as though they absorb some of the force that, previously, would have caused the SI joint to move out of place.

Having strong muscles is like a built in support system… it just makes everything easier.  Even if your SI joints are out of alignment, when your muscles are strong, it somehow seems to affect you less, just because you have more strength everywhere else to rely on.

Being in the water also helps to flush inflammation and toxins out of your tissues more quickly.

I’ve written about this concept before… it’s called hydrostatic pressure.  Essentially, when part of your body is underwater, it’s like the pressure of all the water around it gently compresses your tissues… it’s almost like those compression stockings you see people wear.  Basically, that gentle pressure helps your circulatory system remove waste products more easily, so it can be a great way to help reduce inflammation in your SI joints and lumbar spine (or anywhere else).  I think it’s a great tool that I still take advantage of.

Okay… this (as usual!) was a fairly complicated post.

Whenever I start to get multiple emails on a given topic, I take it a sign that I should probably try to provide some answers on my blog!  So I hope this was helpful for you.

Some related posts you might find interesting:

SI Joint Mechanics:

Aquatic Therapy:

As always, if you have any questions, you can leave a comment below or email me at sunlightinwinter12@gmail.com.  Thanks!

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