Clinical Decision Making in a Patient with Poor Outcomes After Lumbar Fusion: A Case Report

Background: Lumbar fusion surgeries have increased significantly in the United States during the last two decades. However, patients undergoing lumbar fusion often continue to experience pain and disability for extended periods after surgery. Many factors may contribute to these poor outcomes. Rheumatoid arthritis (RA), an auto-immune disease characterized by destruction of synovial joints, is associated with significant pain and work-disability. Research regarding the implications of RA involvement in lumbar spine pathology, and the treatment of these pathologies, is relatively limited. The purpose of this case study is to examine the clinical decision-making process in physical therapy treatment for a patient with rheumatoid arthritis and poor outcomes post lumbar fusion, considering existing evidence. Case Description: A patient presented to physical therapy with a history of a T10-pelvis fusion, rheumatoid arthritis, and chronic pain with complaints of severe left-sided hip pain. At the time of evaluation, nineteen joints had signs of active RA involvement. Intervention: The patient presented with suspected involvement of multiple types of pain. Evidence for the patient’s various components contributing to her pain were utilized to determine interventions for this case study. Discussion: Addressing multiple aspects of the patient’s symptoms provided mild pain relief and improved patient’s participation in functional and recreational activities. Given the chronic nature of the patient’s pain, providing education, acute pain relief, and management techniques was an important aspect of the treatment plan