Baltimore can get cold in the winter! Mind you, I said can get cold, but lately it seems to be more temperate – maybe it’s the fake news of “Global Warming” conspiracy by the Democrats …oops! Anyhoo … Who here remembers leaving the outside water tap open just enough to allow a trickle of water when temperatures got below freezing? We did, but why? Exactly! If the water sits still in the pipe during freezing temperatures then the water will freeze and burst your pipes, and who wants that disaster? If the water is moving, even at a trickle, it doesn’t freeze. Common sense: still water freezes faster than moving water. Are ice cubes in the freezer smooth or jagged? The frozen water on the ground beneath the tap is smooth or jagged? Keep this analogy in mind as we dive into spinal fusions: What they are and why they work.

Intuitively most people guess that a “spinal fusion” is when two bones are fused together, but how does this happen? Back in the old days (and sometimes still today) the surgeon will shave some of the bone off the top of the hip bone, the ilia, then place the live bone between two spinal bones (vertebrae) where the disc (shock absorber / cushion between the vertebrae) has deteriorated. The person was placed in a “clam shell” type of brace for the back and then waited for the live bone between the vertebra to grow into the nooks and crannies of the bone above and the bone below, creating a union between the two, thus taking two bones and making one solid bone.

Technology has advanced in the nearly 30 years I have been working in rehabilitation and now they can use a titanium cage to help hold the bones together around the degenerated disc, thus creating a bridge around it. A titanium cage has pedicle screws, whereby two screws are inserted in each of the vertebrae above and below the targeted sick disc. The two vertebrae are then joined together with rods linking the bone above to the one below. There are several options for how to fill in the space where the disc used to be, including taking some bone from the top of the hip or from a cadaver, but artificial fillers also are used. The goal at this point is to allow the bone to grow into the nooks and crannies of the hardware and the filler material (whether your bone, someone else’s, or whatever).

Remember the story of the freezing water? This is where we make use of it. You need to be the closed tap during recovery. You want your fusion to be solid, strong, smooth … and the only way for that to happen is to not bend, lift, or twist your spine around the fusion. If you are more of the dribbling tap (don’t worry, I can treat that too; after all, I’m a pelvic specialist!) and you keep “breaking your precautions,” then the bones will not grow together as solidly, may be jagged, and will take longer to freeze. This is why you will meet the rehab team in the hospital to go over how to get out of bed. They will guide you on how to use a cane or walker, sock donner, reacher, and the mystical dressing stick! These are tools designed to allow you to remain independent while maintaining your precautions.

If the above situation describes you, do not suffer in silence! I will be having a free zoom presentation on low back pain and sciatica on Saturday, June 13th, 2020 at 10 am. Email me at for more information about getting your back pain sciatica cured without pills injections or surgery.