[Auric]

#5058

Today I’m five weeks out of ACDF without plating, single level C6/C7 with Peek Cage and bone putty. Four days ago, I returned to weight lifting. So far, squats and deadlifts are the only two exercises I have not attempted.

I have squatted for decades. I’m fifty-five now. Squats have been the mainstay of my training, and in numerous seasons, I have proven to myself that they excel all other movements.

Elsewhere on this site you spoke cautiously about squatting in regards to shearing on the back. I’m not sure of the context, and I don’t think it was related to a neck or surgery issue.

My questions about squatting are in regards to an ACDF.

1. Does a high bar squat put undue pressure on a C6/C7 area of the neck after an operation?

2. What measurement could be used as a green light to return to squatting?

Continued thanks for your feedback.

[Donald Corenman, MD, DC]

#5063

Squats are detrimental to some individuals with lower back disorders but the stress placed on the neck is much less than the lower back. Since you have had a fusion with PEEK cage and “bone putty”, the time to fusion will be longer- most likely 12 weeks. I would not put undue strain on the fusion with high bar squats until fusion is confirmed by X-ray. The chance of ruining the fusion is there with increased stress. I would focus more on cardiovascular training than muscle mass until the fusion is solid.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[Auric]

#5065

When you say, “until fusion is confirmed by X-ray,” does that mean the beginning of fusion? A certain percentage of fusion? I had been under the impression that total fusion takes about a year.

As noted in another thread, my surgeon doesn’t order post-op X-rays. I’ll have to ask for them specifically.

[Donald Corenman, MD, DC]

#5066

Fusion that occurs after ACDF depends upon the graft material used and skill of the surgeon. Autograft (from the iliac crest) normally heals in 6 weeks. Allograft (donor bone iliac crest) normally heals in 12 weeks. PEEK cages with bone graft in the center normally heal in 3-4 months as does allograft fibula (bone from the leg).

Healing time depends upon the skill of the surgeon to distract the vertebral bodies, mill the endplates flat, parallel and smooth and the choice of the graft. PEEK cages are essentially an inert plastic spacer the keeps the vertebral bodies separated while bone fusion occurs in the center of the cage. Since the cage itself is inert and has no healing ability, the surface area of the active healing area is reduce and consequently, with less surface area, healing is slower.

I tend not to allow my patients to participate in weight lifting until the grafts are incorporated but I encourage cardiovascular training like the use of a stationary bike,
and elliptical without use of the arms or walking and hiking with restrictions.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[Auric]

#5068

Thanks Dr. Corenman. I can see how less “bone-on-bone” surface area can slow fusion.

My surgeon cleared me to train after three and a half weeks, but when I mentioned squatting, he said six weeks. That would be next Monday. Your caution will probably push that back further.

1. Are there any subjective warning signs that fusion is not happening, from the patient’s point of view?

2. Does plating (or lack thereof) alter rehab time frames?

[Donald Corenman, MD, DC]

#5079

If for some reason the fusion does not occur (known as a pseudoarthrosis), symptoms may or may not occur. I have seen patients with a pseudoarthrosis have no symptoms. This is known as a stable pseudoarthrosis. I have however seen these patients with a stable pseudoarthrosis eventually develop symptoms.

If the fusion does not occur and you develop symptoms, these symptoms will typically occur within 4-12 months and typically involve neck pain.

Plating increases the chance of fusion as it immobilizes the level involved. I believe plating allows the patient to mobilize faster with less restrictions.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

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