Follow up care after spinal fusion surgery
I recently watched an interview between Dr. Hagit Berdishevsky, who is a preeminent physical therapist in conservative care for scoliosis, hyperkyphosis, posture, and back care, and Dr. Lenke, who is a leading expert in complex spinal deformity surgery. About 30 minutes into the interview, Dr. Berdishevsky asked Dr. Lenke about his general guidelines to follow up care after spinal fusion surgery. Dr. Lenke replied that once patients are discharged from the hospital without complications he sees them again at 2-months, 6- months depending upon the case, 1-year, 2-year, 5-year, and then every 5-years as long as everything is going well. He never tells someone not to come back for follow up.
Post spinal fusion surgery
At this point, I thought, “I haven’t seen a doctor for follow up since I graduated from college. That’s two decades!!!” I had follow up visits until one year after my surgery. Then the only follow up visit was ten-years after surgery. I requested an appointment with my original surgeon. I’d been in an ugly car accident before spring break of my senior year. After making dinner and watching Grosse Point Blank, I was driving my two friends back to Notre Dame’s campus when we were t-boned by a drunk driver. I suffered the least with some intense whiplash. After graduation, I wanted to make sure that my back didn’t have any injuries that I couldn’t feel and that my hardware was still intact. Fortunately, all was well.
When I heard Dr. Lenke’s words I felt a bit like the dentist with bad teeth. I have many colleagues, friends, students, and clients with scoliosis spinal fusions. I know the stories of people with issues above and below the fusion (adjacent segment disease), broken instrumentation, and other complications. Why didn’t I realize that we should check-in with a doctor every now and then?
Truth be told, many of us diagnosed with idiopathic scoliosis during our teenage years received information that indicated spinal fusion surgery would fix our scoliosis. The doctors that performed these surgeries likely believed this as well. Our doctors didn’t recommend that we return for follow up care because they probably thought we didn’t need it. In addition, many of us never even received physical therapy.
Scoliosis Research Society
Instead of dwelling, I dug a little deeper. I found a very interesting page on the Scoliosis Research Society’s (SRS) website about this subject [1]. SRS is the professional society for surgeons that specialize in patients with spinal deformity. Note: the choice of the words “spinal deformity” is not mine, it’s the organization’s logo.
SRS wrote in the original introduction to this web page, “When we mentioned in a previous post that once you have spine surgery your surgeon and his/her team would like to follow you forever, the following study is a good example of that!” By the time I found the article, the intro sounded a little more like this,
Update 03/15/18: In the initial article, it was stated that “your surgeon and his/her team will follow you forever”. The onus is on the patients to return for post-operative appointments as recommended by their surgeon. After the first few years post-op, the visits are generally less frequent and eventually only every 5-10 years. If a long-term study is being done, letters will often be sent to patients that had the type of surgery that is included in the study to ask them to return for an evaluation. If patients haven’t been to the office for a long time or their contact information is not current, that makes it difficult. Regular x-rays and visits are important to catch and treat problems before they become too serious.
SRS complaints
I imagine that SRS received an uproar of complaints from both patients (who were never told to seek follow up care) and doctors (who tried to offer follow up care to find some patients unresponsive and some doctors who never recommended follow up care at all). There’s a glimpse of history in that note and more importantly the recommendation is clearly stated. Follow up care is important in order to find problems before they become too serious.
I like to think that if problems are found before they become too serious conservative care options for treatment (ie. not surgery) might have higher success rates.
In closing I’d like to share that I did get a proper scoliosis x-ray in 2019 before attending a continuing education class on Pilates & Scoliosis. Hagit Berdishevsky and Lise Stolz co-taught the workshop. Lise knew that I ran into some difficulties in my Pilates comprehensive training and reached out to recommend that I get an x-ray before attending the workshop. She was even so kind as to organize the images and measure the Cobb angle. From this x-ray and the associated report, I feel like I have a strong sense of my spine’s health. From my recent foray into follow up care after spinal fusion surgery, I am committed to finding a spine specialist when this pandemic is over (and hopefully I know where I’m going to live) in order to have continuing care and follow up.
