Pseudoarthrosis or instability occurs as complications from failed surgery. If a patient has an unsuccessful first surgery, the likelihood of a second surgery being successful is 30%. The likelihood of a third surgery’s success is 3%.
The role of the occupational medicine doctor is to be supportive, provide medication and monitoring, and treatment for flare-ups. These patients may need intermittent use of opioids –generally 20-30 tablets/month maximum is dispensed, and many benefit from scheduled use of NSAIDS. Cbc, chemistry profile, and stool hemoccults should be performed every 3-6 months to monitor NSAID use. Patients necessitating intermittent narcotic use should be carefully reevaluated to insure that the side effects don’t outweigh the benefits (such as depression, decreased energy or mentation, etc.).
As with other back conditions, the patient should be encouraged to remain physically active. Physical therapy is essential: emphasis should be on education, functional restoration, and a stabilization program. A home program should be prescribed and emphasized. Lumbar support or brace can be helpful for flare-ups.
Depends on level of conditioning and motivation of the patient. It is generally necessary to restrict the patient from heavy lifting (over forty pounds), from repetitive lifting (over 10 pounds), and from repetitive bending.