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This is a piggy-back of the facet pain after fusion thread. I get a ton of patients who have persistent back pain after posterior lumbar fusion. I understand adjacent level facet pain, including SI pain. However many of these patients have incomplete response to facet targeted therapy.
I understand pain from neurogenic claudication, but the vast majority of these patients seem to have nociceptive pain. Common symptoms are equally painful lumbar flexion/extension, and sometimes tenderness over the fusion site even 1+ years after surgery. Any other ideas what can be helpful for these patients? If the pain source is altered biomechanics, are certain PT modalities helpful?
I understand pain from neurogenic claudication, but the vast majority of these patients seem to have nociceptive pain. Common symptoms are equally painful lumbar flexion/extension, and sometimes tenderness over the fusion site even 1+ years after surgery. Any other ideas what can be helpful for these patients? If the pain source is altered biomechanics, are certain PT modalities helpful?