The Confusion of Fusion

Here is a simple word problem. There is a group of ten people. Each person holds a fruit basket with six apples in each for a total of 60 apples. When they are told to begin, each person places an apple in someone else’s basket. They repeat this for the next five minutes. When the group stops how many apples do they have in total? The answer is 60. Some might have more apples in their basket and others may have less, but the total still remains 60. No apples were lost nor gained. The same can be said of human movement.

Each joint in the body has an ideal amount of movement it is responsible for at any given time. Similar to the word problem, the joints always add up to a certain amount of movement for someone to travel from point A to point B. Let’s just use 100% for the sake of argument. Each joint should have a certain percentage of participation. The bigger joints, like the hips, shoulders, and ankles, typically would have a greater percentage. Meanwhile, the spine, hands, and toes would have a smaller percentage. What would happen if one of the joints reduced its percentage of movement? This could happen due to injury, surgery, lack of movement, or a myriad of other physical, hormonal or emotional elements. The body would still need to achieve 100%. Somewhere else would need to compensate and increase its percentage of movement to get the total to 100%. If this altered pattern of compensatory movement were to continually be reinforced, many reactions would take place: muscular imbalances, postural distortion, compromised gait patterns, joint and soft tissue wear and inflammation, as well as hormonal and organic stress.Lumbar SideLumbar Front

Now imagine what it would mean if a joint were to be fused, so zero movement was allowed. It happens quite often, especially along the spine. Several legitimate scenarios are given for spinal fusion including trauma, tumors, and infections. However, many patients receive fusion because they are exhibiting weakness and pain in a certain area of the body due to degradation or malalignment.

A person unconsciously compensates for restriction in one area of the body only to have another area wear down so much that surgical fusion is recommended. The surgeon will take bone from the pelvis or a cadaver and place it between two or more vertebra to fuse them together. The affected area had worn down, from improper movement, so much that now the exact opposite is prescribed. All or nothing. Instead of a high percentage of participation, there is now 0%. What would you predict would happen next? Remember the total still needs to reach 100% no matter what. Perhaps you will begin to see the neighboring joints above and below the fusion take on a greater percentage? Or perhaps the fusion breaks apart from the continued force in that region? If either occurs it will not be long before another fusion is recommended.

The whole trouble with this problem-solving approach to fusion is that, at no point in time, did anyone take a step back and look at how the entire body was organizing movement and what each joint’s participation percentage was. There is no need to blame the doctor because they are not taught such things in medical school (If a hammer is your only tool…). Perhaps if that was taken into consideration the powers that be might have determined something else? Perhaps they might have discovered that the restriction in the person’s right big toe was limiting the range of motion in the hip and caused the spine to compensate enormously? Or perhaps it was the history of shoulder dislocations that tightened up the shoulder blade and asked the spine to move more? Or maybe it was the whiplash from the car accident that occurred 15 years ago that forced the lower back to take up the slack of the injured neck? Really there are an infinite number of possibilities which could occur to ask the body to adapt and compensate. Determining how the body moves, then encouraging and guiding it to move in a more efficient and proper manner might reduce the need to compensate and wear down areas that do not deserve such punishment.

So if you have been considering some type of surgical fusion, you might want to consider other options. All or nothing are just two options, there is always a third that is usually somewhere in between.