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MSK 2 > 1h - Cspine Rehab and Surgical > Flashcards

1h - Cspine Rehab and Surgical Flashcards

1
Q

what is the key intervention for multimodal treatment

A

education

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2
Q

what is criteria for d/c traction

A

when pt doesn’t need it anymore bc pain is centralized and don’t have pain in extremities anymore
- could regress to joint mobs and strengthening

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3
Q

what is an important thing to do at the first visit bc “break ups” w pts can be hard

A

set expectations regarding length of care, pt and PT goals, prognosis, and goal of transition to independence w HEP

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4
Q

what is dc of PT criteria

A

dc when goals achieved -or- pt not progressing

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5
Q

what are goals to achieve by dc

A

long term functional outcome
associated impairments (STG)
- functional stability/endurance
- premorbid activity level
- independent HEP
- balanced posture

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6
Q

what are impairments that are still appropriate to dc a patient with

A

pain 2/10
80% ROM
strength 4/5

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7
Q

why is pt education an important intervention

A

builds therapeutic alliance
lends to better buy in and adherence to PT exercises

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8
Q

what are things to include in patient education (5)

A

patient centered care
ed on condition/management options
body mechanics
posture
ergonomics

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9
Q

what are 2 criteria for pts to progress to c spine isometric exercises

A

good neck control
asymptomatic

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10
Q

what are 4 main categories of exercise interventions for the cspine

A
  1. motor control / proprioceptive retraining
  2. strengthening and endurance exercises, neck and upper quarter
  3. aerobic conditioning
  4. functional training
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11
Q

what is the mulligan concept

A

adjunct to treatment (central and unilateral PAs) in plane of facet in superior direction

  • aka mobilization with movement -> apply concurrent accessory motion during active physiologic mvmt to end range
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12
Q

what are the parameters for mulligan treatment and what are the 2 most important ones and why

A

*P - pain free
*I - instant result
LL - long lasting

if not pain free & no instant result, need to adjust

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13
Q

what are 3 techniques that are part of the mulligan concept

A

NAGS - natural apophyseal glide
SNAGS - sustained natural apophyseal glides
MWMS - mobs w mvmts

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14
Q

how is SNAGS implemented in the cervico-thoracic spine

A

pt performs symptomatic mvmt, PT applies SUSTAINED accessory glide during movement

must result in full range pain free mvmt

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15
Q

how are NAGS implemented in the cervico-thoracic spine

A

OSCILLATIONS that can be applied to facet joints C2 - T3

applied mid to end range

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16
Q

how are MWMs implemented in the cervico-thoracic spine

A

as spinal mob w limb mvmt
transverse pressure at side of relevant SP as pt moves limb thru previously restricted ROM

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17
Q

what are ms energy techniques

A

use voluntary ms contractions exerted against precise counter force to inc joint ROM

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18
Q

how does ms energy work according to physiologic principles

A

joint mob force
post isometric ms relax (autogenic inhibition)
reciprocal inhibition

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19
Q

what is the technique used to ms energy

A

engage restrictive barrier in all planes (combined mvmt pattern)

provide gentle isometric resistance
hold for 5-10sec
wait for complete relaxation of ms
reposition to engage new barriers
repeat sequence

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20
Q

what is strain-counterstrain

A

positional release
indirect technique for somatic dysfunction, place body into position of ease, ms in maximally shortened position

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21
Q

who is a strain-counter strain technique good for

A

pts w pain and guarding in ms
pain w ms contraction

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22
Q

what is the technique for strain-counter strain

A

locate and palpate tender point while ms is in passively shortened position
- palpate tender point in that position and hold for 90-120sec until feel ms point relax and return to resting position

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23
Q

what are 5 medical interventions for neck pain

A

pharm
epidural steroid injections
surgery
prolotherapy/regenerative injection therapy
radiofrequency ablation

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24
Q

what are meds that may be used for neck pain

A

analgesics/NSAIDS
short term opioids
oral steroids
ms relaxants (neuro pain)

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25
what is radiofrequency ablation
(rhizotomy) non surgical, minimally invasive procedure that uses heat to reduce or stop transmission of pain
26
what is the most sensitive diagnostic imaging that can be used for neck pain
MRI
27
what are MRIs very sensitive in detecting and what is a consideration of this
soft tissue (ie disc) abnormalities can see high incidence of abnormalities in asymptomatic pts
28
when is it appropriate to get an MRI for neck pain
if considering surgery
29
other than MRI, what are 2 other dx tests that can be done
electrodiagnostic testing - EMG - nerve conduction studies
30
transforaminal vs interlaminar injection
transforaminal - most common - more target specific - more potential complications interlaminar - med close to assumed site of path
31
what is the purpose of injections
to inject a med (ie corticosteroid) around nerve root to dec inflammation
32
when are injections indicated
not benefiting from traction w arm pain
33
what is a commonly used med for injections
methylpredisolone
34
what is part of the procedure for injections
fluoroscopy is used to guide the injection
35
who may epidural injections be considered for
pts w cervical radiculopathy from degenerative disorders
36
what is the main patient who will benefit from injections
someone w disc herniation + radiculopathy
37
what does the evidence say about the the use of epidural injections for pts w chronic neck and UE pain
combo of pharmacotherapy, PT, and epidural may be more effective than either approach individually
38
what pt is the evidence GOOD for a cervical epidural w local anesthetic and steroids
cervical disc herniation
39
what does the literature say about the use of local anesthetic vs cervical epidural + local anesthetic + steroids only for cervical disc herniation
fair for use of local anesthetic only - good for the other
40
what pts is the evidence fair for use of local anesthetic (w or w/o steroids) - 3
axial or discogenic pain spinal stenosis post-surgery syndrome
41
what is a consideration of the use of epidural injections
potential complications d/t invasive nature
42
what are 4 indications of surgical intervention being needed
1. no improvement w non-surgical treatment in 6-12wks (PT, injections, meds, etc.) 2. neurologic compression - progressive motor deficit w radiographic correlation - need surgery urgently 3. instability 4. deformity
43
what are 2 anterior approach surgical procedures
ACDF - cervical discectomy w or w/o fusion ACD (TDR) - disc arthroplasty (artificial disc)
44
what are 3 posterior decompression surgical procedures
foraminotomy laminaplasty laminectomy
45
what is a laminectomy
removal of vertebral lamina to decompress SC (w or w/o fusion)
46
what is a laminoplasty
lamina is moved to expand space for SC
47
what is a foraminotomy
intervertebral foramen or canal is enlarged w goal of removing tension or compression on nerve root - only the portions of disc that are pressing on nerve root are removed
48
what are indications for a discectomy & what are the 2 strongest indications
STRONG - acute myelopathy or myeloradiculopathy (affecting gait, LE weakness) - progressive neuro deficit ADDITIONAL INDICATIONS - failure of conservative treatment (refractory) - significant motor deficit - severe incapacitating pain (not responding to any form of treatment) - as long as corresponding imaging
49
what does ACDF stand for
anterior cervical discectomy and fusion w anterior cervical plate fixation
50
what are 4 types of materials used for an ACDF and what is the most typical
allograft bone autograft bone synthetic alternative PEEK cage most done w small ant plate w screws for stabilization
51
what is the purpose of a plate in an ACDF
stabilize while bone heals
52
how does the spine heal after an ACDF
bone fuses and becomes solid block of bone which allows for no motion
53
what are typical precautions after an ACDF
lifting and activity restricted for first 6wks **no traction or manip for 3 mo **no joint mob near replaced segments
54
what is the rehab focus post-op ACDF
ice to neck 10min up to 3x/day walking program deep neck strengthening and stability exercises
55
what is the most important precaution after an ACDF
**no traction or manip for 3 mo **no joint mob near replaced segments
56
what are 3 common temporary sx post op ACDF
hoarseness difficulty swallowing dizziness
57
when does PT start after ACDF
weeks 3-6
58
what does PT in the hospital post ACDF look like
log rolling/posture walking progression cervical collar
59
how long can it take for graft to heal post ACDF
up to 1yr
60
rehab plan weeks 1-2 post ACDF (3)
progress walking & endurance gentle AROM PAINFREE no lifting >10#
61
rehab plan weeks 2-4 post ACDF (3)
AROM R & L (may use 2 finger to provide assistance) aerobic exercise - walking/UBE deep neck ms strengthening - isometrics
62
what is the goal of rehab weeks 4-12 post ACDF
return to PLOF
63
rehab plan weeks 4-12 post ACDF (3)
progress lifting
64
rehab plan 3-6mo post ACDF (2)
self progression on higher level activities progress exercises
65
why might a pt still have arm pain after an ACDF
can happen if disc was compressing nerve root for weeks - lots of inflammation had formed and takes time to resolve
66
what negative outcome is associated with spinal fusion seen in ACDF
adjacent segment dz
67
why might someone develop a clinically significant disc dz at levels adjacent to fused discs in ACDF (3)
altered biomechanical stresses surgical disruption of soft tissue natural hx of cervical disc dz
68
outcomes from an ACDF vs non-surgical management and what is the take away from this
surgery resulted in more rapid improvement in 1st year post op - after 2 years no different - no difference in long term outcomes structured PT should be tried before surgery (if possible)
69
what is the significance of a Mobi C as an artificial disc device
bone sparing fixation
70
what is the significance of a simplify disc as an artificial disc device
allows for use of MRI imaging
71
what are 3 indications for cervical disc arthroplasty
1. skeletally mature 2. clinically symptomatic cervical radiculopathy and/or myelopathy d/t neural compression C3-C7 at 1 or 2 contiguous levels 3. failed at least 6wks of nonsurgical treatment and shows signs of progressively clinical deterioration
72
what is a clinically symptomatic radiculopathy or myelopathy that would indicate the need for cervical disc arthroplasty
intractable radiculopathy (arm pain and/or neuro deficit) w or w/o associated neck pain myelopathy (d/t abnormality localized to level of disc space)
73
what are 6 contraindications for a cervical arthroplasty
1. infection in spine or surrounding areas 2. osteoporosis or osteopenia - not good bone to attach to 3. severe degenerative changes/facet dz - artificial disc allows mvmt, if facets stiff/degenerative will undergo more stress and not tolerate additional movement well 4. cervical instability 5. allergy to metals and other materials in artificial disc 6. hybrid procedure for multi-level ACDF and TDA - fusion at one level, artificial disc at another
74
what is the main difference in the rehab protocol b/w ACDF and a disc arthroplasty and why
no concern ab healing fusion/protecting the graft in a disc arthroplasty - disc removed and replacement moves so don't have to worry ab protecting fusion
75
why does disc arthroplasty heal faster than an ACDF
less invasion no fusion to worry about
76
what are the phases post a disc arthroplasty
phase 1: protection phase - some restrictions wks 1-3 phase 2: intermediate phase 3: advanced strengthening phase 4: return to activity
77
what are 4 pros of TDR vs ADF
better clinical outcomes greater segmental motion dec rate of subsequent surgeries lower rates of adjacent segment secondary surgeries
78
what is one con of TDR vs ACDF
longer term follow-up needed
79
what is the timeline for PT post a TDR
might start PT at 2wks unrestricted return at 4wks
80
what are 3 pros of ACDF vs TDR
treat wider range of pts - not everyone is eligible for an artifical disc fewer unknown risks less complicated procedure

MSK 2 (20 decks)

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