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tata
07-26-2011, 12:44 AM
Has anyone tried GPR (Global Postural Reeducation) therapy after having several vertebrae fused?

Pooka1
07-26-2011, 06:21 AM
Are you asking if PT can overcome an unbalanced fusion?

That's a good question. I hope someone has the answer.

The only thing I have heard remotely connected to improving spinal balance post-op in a conservative way is a few kids who appeared to have double major curves only had the T curve fused and were braced for a few months for the lumbar. Apparently that is claimed to work at times but I would like to see some evidence.

Pooka1
07-26-2011, 06:22 AM
By the way, Alexander Technique is said to be highly effective at this sort of thing and might be worth a try even with a fused spine.

tata
07-27-2011, 01:28 AM
Thanks very much for the info. I don't know about the Alexander technique but I'll find out.

I didn't really mean to use GPR after a wrongly fusioned spine but to perhaps correct/minimise overloads/compensating curves on the non-fusioned vetebrae.

My cervical area has an inverted curve and a disc hernia; both are causing me disconfort and pain, more now than prior to surgery. I take it there's a double reason for that: one, my back hurts less now and so I pay more attention to my neck, two, my neck could be trying to compensate what surgeons have "unnaturally" fixed.

I stretch my neck (and the rest of my back and my legs) every day but I also was wondering if GPR might help. I however have only found one specialist close to where I live but he doesn't have experience with fused patients and he's not sure if treatment might be counterproductive.

Pooka1
07-27-2011, 06:42 AM
Is your thoracic kyphosis within normal range? Can you ask the surgeon if the curvature in your neck is compensatory to anything? Have you ruled out that it is structural?

It's my understanding that fusing structural curves, picking the correct levels proximal and distal levels, and hitting the balance in all three planes is what drives correction of compensatory curves. This means straightening the structural curve in the coronal plane, putting in or removing curve in the sagittal plane to establish a normal range in kyphosis and lordosis, and removing as much rotation as possible in the transverse plane.

For both my daughters, the thoracic fusion decreased or removed the compensatory curve in their lumbar, restored a normal range of kyphosis, and greatly derotated them. They both have good or excellent balance in all planes. It happens automatically as a result of a correctly done fusion and is why it is important to get a great surgeon.

That said, I am getting the impression from reading testimonials that balance is not achieved in some cases despite the best efforts of the surgeons. For example, they are still publishing the pros and cons of picking certain fusion levels over others. There is not complete consensus which indicates to me that that the condition might be too variable to have one set of fusion "rules."

It is an interesting question about how much of any abnormal compensatory curvature in any plane can be corrected with PT (or brace) after a fusion. I bet at least some of it can be addressed conservatively if it is compensatory and if the fusion is balanced to begin with but of course I don't know that. Not my field..

Good luck.