Chiropractic Care & Spinal Fusions: A Patient Case
Understanding Spinal Fusions
Spinal fusion was first performed over a century ago, but in recent decades, it’s become far more common. According to a review from the Journal of Spine Surgery, fusion rates in the lumbar spine alone have increased by more than 170% since the 1990s. This has been attributed to improvements in fusion technology, technique, and safety, as well as broader implications for its use (Reisener et al., 2020).
Today, reasons for fusion include:
Joint/disc degeneration
Traumatic injuries and fractures
Infection
Severe scoliosis
Symptomatic spondylolisthesis
Radiculopathy & neurogenic claudication
When conservative treatment fails to resolve back-pain related disorders, spinal fusion is the standard surgical procedure (Machino et al., 2022). In many cases, this is necessary to restore structural integrity and protect neurological structures. But there are three important questions that should be addressed…
What are the long-term consequences of spinal fusion?
How can we best manage these consequences?
Can chiropractic care play a role in preventing spinal fusion?
Adjacent Segment Degeneration (ASD)
A review from the Journal of Orthopaedic Surgery and Research defines ASD as post-operative radiographic changes (disc herniation, joint degeneration, etc.) observed in the spinal segments adjacent to a fusion.
ASD is estimated to affect 1/3 of patients within 2-7 years (Machino et al., 2022).
When these changes are associated with new onset of clinical symptoms, this is termed adjacent segment disease (Machino et al., 2022).
So what exactly causes ASD?
Collateral tissue damage caused by fusion techniques
Compensatory hypermobility and altered spinal biomechanics
Machino et al. covers both of these components in the following list, arranged in order from most to least impactful…
Ligament damage
Muscle damage
Immobilization
Fusion Angle
Facet joint damage
In order to understand this list, we need to discuss how spinal fusions are performed
Spinal Fusion Techniques
There are a variety of spinal fusion techniques, each with their own advantages and disadvantages. For any spinal surgery, our first question is this:
How do surgeons access the spine?
The spine is more than just a stack of bones — it’s surrounded and supported by other tissues (muscles, fascia, ligaments, viscera/organs, and neuro-vascular structures). No matter which direction the surgeon enters from, they must separate and/or cut through some of these tissues in order to access the spine.
The following graphic from Machino et al. helps illustrate this…
Based on their review of the scientific literature, the authors concluded that…
Surgical approaches cause long-term muscular damage (fibrosis, atrophy, or fatty infiltration)
Local muscle damage appears to have global effects on spinal stability and loading
The extent of damage depends on the size and type of surgical access
Muscle sparing techniques are associated with lower rates of ASD
Unfortunately, muscle sparing is not often feasible (practically or financially).
Not only that, but once the muscles and/or viscera are navigated, there are still spinal ligaments and joint structures that must be moved out of the way. Another image from Machino et al. demonstrates two ways that this might be achieved…
This review from the Journal of Orthopaedic Surgery and Research concluded:
Spinal ligaments provide structural stability, and communicate proprioceptive information to the central nervous system (necessary for active stability)
The facet joints contribute 49% to axial rotation stability
Facet compromise increases shear and rotational stress on the disc
Greater injury to the posterior complex is associated with higher incidence of ASD
Reisener et al. provides a helpful table to explain all of the advantages and disadvantages of various surgical techniques, including the risk of injury to nerves and blood vessels. But the main takeaway is this:
Spinal fusions are no small feat! There are many factors involved, and collateral damage cannot be avoided.
Compensations: How Does the Spine Respond to Fusion?
When a spinal fusion locks two or more vertebrae together, it changes how the entire spine moves and absorbs stress. The fused area becomes stable — which is exactly what the surgery is meant to achieve — but that stability comes with a trade-off: the joints above and below must now handle more motion, more force, and more stress.
Biomechanical studies have shown increased disc pressure and articular cartilage stress in the adjacent segments both above and below spinal fusion. Additionally, fusions with greater immobilization (more hardware and/or higher number of fused segments) are associated with even greater biomechanical stress, and higher risk of developing ASD (Zhang et al., 2025) (Reisener et al., 2020).
Immobilization = compensatory hypermobility & altered biomechanics = excess wear/tear = ASD
As we saw above, collateral tissue damage also contributes to excess wear/tear and higher risk of ASD.
For this reason, many patients with one spinal fusion are told that additional fusions may be necessary in the future. But what if we could interrupt the progression of compensations, leading to ASD?
The Gonstead Chiropractic Perspective
In many cases, spinal fusions are necessary and crucial for the restoration of structural/neurological integrity. But did you know that proactive, conservative care could prevent the #1 cause of fusion? According to Reisener et al., the most common cause of spinal fusion surgery is lumbar degenerative disc disease.
In our first blog post, we discussed Dr. Gonstead’s six stages of disc degeneration. In short, it begins with an injury to the disc, which causes inflammation of the disc, altered load bearing, and vertebral misalignment. The disc is repaired with fibrous scar tissue, which restricts normal joint motion. Over time, this leads to dehydration and thinning of the disc. Eventually, bony/arthritic changes will follow.
Degeneration is often portrayed as a natural and unavoidable product of aging. But if a specific chiropractic adjustment can break up fibrous adhesions, correct spinal misalignment, and restore normal load bearing of the disc, then it can interrupt the degenerative cascade. This is great news!
Still, there are many other causes of spinal fusion which may be unavoidable. So the next question is this:
Is chiropractic care safe and beneficial for patients who have a spinal fusion? — Absolutely!
As Gonstead chiropractors, we use a very detailed and thorough analysis to tailor care to each patient’s individual needs. Surgical hardware is merely another factor to consider as we personalize your care.
Not only that, but in light of everything we’ve seen about spinal fusions and the potential development of ASD, Gonstead chiropractic care can be crucial for these patients and their long-term spinal health.
A Patient Case from Rise Chiropractic
One of our first patients came to the office for care following a spinal fusion of 6 segments (T10-L3). The surgery was performed about 4 years prior, and she had since developed a variety of symptoms including:
Low back pain
Neck pain
Numbness in the low back, wrapping around the back of the pelvis
As with every patient, we performed a thorough initial exam including thermography and full spine x-rays. We were also able to assess the patient’s initial x-rays (immediately pre- and post- surgery), to evaluate any changes that had occurred since the procedure. Compensations and minimal degenerative changes were observed, but as a relatively young and healthy individual, there were no major developments to note.
As Gonstead chiropractors, we always begin with the foundation of the spine — the sacrum and pelvis. Adjustments were performed both above and below the spinal fusion, but the foundation was our primary concern. Our analysis identified minimal rotation, but a significant compensatory hyperlordosis (excess forward curvature) below the fusion. And within the first two sacral adjustments, we recieved the best news:
“I can feel the shirt on my back again, for the first time in years!”
In the next couple of visits, the patient noted a pain going down her left thigh, and our focus moved up from the sacrum to L4 (directly below the fusion). We performed the first L4 adjustment, and as she rose from the table, the pain was immediately gone!
These are the moments that we live for in practice. We love celebrating your wins with you, and playing a small part in your journey to health. Ultimately, all glory goes to God — our creator and sustainer. We find great joy in serving as His stewards, and vessels for His work.
It has been a pleasure to continue caring for this patient, and we look forward to seeing many more like her!
References
Machino, M., Ando, K., Kobayashi, K., Ito, K., Tsushima, M., Morozumi, M., Tanaka, S., Hida, T., Ito, S., Ota, K., & Imagama, S. (2022). Adjacent segment degeneration after lumbar fusion: A systematic review. Journal of Spine Surgery, 8(4), 479–493.
Reisener, M. J., Pumberger, M., Shue, J., Girardi, F. P., & Hughes, A. P. (2020). Trends in lumbar spinal fusion: A literature review. Journal of Spine Surgery, 6(4), 752–761.
Zhang, L., Yu, Z., Zhang, X., Zhan, H., Wang, K., Zhao, Y., Zheng, W., & Sun, Y. (2025). Finite element analysis of pedicle screw fixation biomechanics and adjacent segment degeneration in varied bone conditions. Scientific Reports, 15, 19047.
