Yes, you can adjust someone who has a spinal fusion. Actually adjusting the spinal fusion is another question. First off, we need to define what a spinal fusion is. 

A spinal fusion is when two or more spinal bones attach together. Not all fusions are the same.

Spine bones can be naturally fused together. These are congenital fusions. Examples of congenital fusions occur in conditions such as Klippel-Feil Syndrome and Block Vertebra Syndrome.

Spine bones can be pathologically fused together. These are acquired fusions. These types of fusions are seen in conditions such as tuberculosis, and juvenile rheumatoid arthritis. It can also occur with different types of physical traumas.

Spine bones can also be artificially fused together. These are surgical fusions. Surgical fusions of the spine have different procedural names but are often categorized as either anterior fusions or posterior fusions. 

All fusions change the biomechanics of the spine. If spinal bones are fused, mobility is compromised. Joint mobility is significantly decreased. Because of this, joints above and below the fusion compensate for this lack of movement. They become hypermobile. This means there is more than usual movement and mobility in the joint. 

 So, can you adjust a spinal fusion? 

When adjusting someone who has any type of fusion, precautions are warranted. It will depend on the type of fusion, the location of the fusion and the individual situation. 

It is contraindicated to adjust any bones that have been surgically fused. Because a surgical fusion involves medical hardware that aims to prevent spinal movement, it is in the best interest of the Chiropractor to avoid adjusting this area entirely. It is possible to adjust bones above and/or below the surgical fusion but not without extreme care and deliberation. This is a prime example of how the specificity of the adjustment is paramount to Chiropractic. 

Adjusting an acquired fusion is an option but again not without extensive analysis. If the pathology is active, meaning the disease is in the process of fusing the bones, adjusting is contraindicated. You can adjust bones above and below an active pathological fusion but with specificity and individual patient concern. If the acquired fusion is stable and has structural integrity, it is possible to adjust it. This again is a situation that requires a case-by-case analysis.

It is possible to adjust congenital fusions. These need the same attention to detail as other fusions. Congenital means “born with” so these fusions are the most natural type of fusion. Because they are the most natural, the biomechanics of the spine are adapted to the fusion. This also means that the spine has greater adaptability to the adjustment as well. 

One of the biggest questions a Chiropractor needs to answer before providing any correction is “does the patient’s body have the potential to adapt to this specific adjustment in a positive way?”. Fused vertebra or not, the degree of certainty to this answer will determine how the Chiropractor will proceed with an adjustment. 

- Jarek Esarco, DC, CACCP

Jarek Esarco, DC, CACCP is a pediatric, family wellness and upper cervical specific Chiropractor. He is an active member of the International Chiropractic Pediatric Association (ICPA). Dr. Jarek has postgraduate certification in Pediatric Chiropractic through the ICPA. Dr. Jarek also has postgraduate certification in the HIO Specific Brain Stem technique through The TIC Institute. Dr. Jarek is happily married to his wife Regina. They live in Youngstown, Ohio with their daughter Ruby.