Patients who have had spinal surgery are often told, vaguely, that they can never see a chiropractor again. That is not correct, but the instinct behind it is reasonable. Post-surgical spines require genuinely different handling, and a provider who treats you the same way they would treat anyone else is a provider to avoid.
Here is what actually changes.
First: What Surgery Did You Have?
The answer determines everything, and "back surgery" covers procedures with very different implications.
Microdiscectomy or laminectomy. Tissue was removed to decompress a nerve; the segment was not fused. Motion is preserved. Once healing is complete, these spines can generally be treated fairly normally, with care around the operated level.
Spinal fusion. Two or more vertebrae have been permanently joined with hardware and bone graft. The fused segment does not move and must never be adjusted. It is not a joint anymore.
Artificial disc replacement. Motion is preserved by design, but the hardware has its own tolerances and manufacturer guidance.
Before treating anyone post-surgically, we want the operative report or at minimum current imaging, obtained through our imaging network if you do not have it. Treating a fused spine without knowing exactly which levels were fused is not acceptable.
The Adjacent Segment Problem
This is the central issue in post-fusion care, and it is why these patients often end up in our office years later.
When you fuse two vertebrae, the motion they used to contribute does not disappear — it gets redistributed to the segments immediately above and below. Those neighbours now do their own job plus a share of the fused segment’s. Over years, that accelerated load produces degeneration at the adjacent levels. It is called adjacent segment disease, and it is a well-recognised consequence of fusion, not a sign that anything went wrong with the surgery.
The clinical implication is important: in a post-fusion patient, the fused level is off-limits, but the adjacent levels frequently need help — and helping them is often exactly what relieves the pain. The goal is to reduce the demand on those overloaded neighbours, which means restoring motion elsewhere in the chain: the thoracic spine, the hips, the sacroiliac joints.
What We Do Differently
- No high-velocity adjustment at or through a fusion. Ever.
- Low-force techniques — instrument-assisted, drop-table, mobilisation — in place of manual thrust techniques near operated levels.
- Emphasis on the regions above and below, and on the hips, to offload the adjacent segments.
- Heavy use of soft tissue work, because post-surgical scar tissue and chronic muscular guarding are frequently a large share of the pain.
- Progressive stabilisation work, since post-surgical patients are usually deconditioned after months of guarding.
Failed Back Surgery Syndrome
The name is unkind and somewhat misleading — it describes persistent pain after technically successful surgery, which is more common than most patients are warned about. Causes include adjacent segment degeneration, epidural scar tissue, a pain problem that was never mechanical to begin with, or central sensitisation, where the nervous system continues generating pain after the original driver is gone.
Conservative care can help meaningfully here, particularly for the mechanical and muscular components. But honesty matters: it does not help everything, and anyone promising to resolve post-surgical pain entirely should be treated with scepticism. Realistic goals are better function, less medication dependence, and fewer flare-ups.
Timing
Nothing manual near the surgical site until your surgeon clears you — typically three months for a discectomy, six to twelve months for a fusion depending on bone healing. We coordinate rather than freelance. If your surgeon has restrictions, those restrictions win.
If You Have Had Spinal Surgery
Bring your operative report and any recent imaging to the first visit. Contact Bromberg Chiropractic in Cambridge, and we will tell you honestly what we can and cannot help with in your specific case — including when the answer is that you need to go back to your surgeon.
