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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
Q

what is radiofrequency ablation

A

(rhizotomy) non surgical, minimally invasive procedure that uses heat to reduce or stop transmission of pain

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26
Q

what is the most sensitive diagnostic imaging that can be used for neck pain

A

MRI

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27
Q

what are MRIs very sensitive in detecting and what is a consideration of this

A

soft tissue (ie disc) abnormalities

can see high incidence of abnormalities in asymptomatic pts

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28
Q

when is it appropriate to get an MRI for neck pain

A

if considering surgery

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29
Q

other than MRI, what are 2 other dx tests that can be done

A

electrodiagnostic testing
- EMG
- nerve conduction studies

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30
Q

transforaminal vs interlaminar injection

A

transforaminal
- most common
- more target specific
- more potential complications

interlaminar
- med close to assumed site of path

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31
Q

what is the purpose of injections

A

to inject a med (ie corticosteroid) around nerve root to dec inflammation

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32
Q

when are injections indicated

A

not benefiting from traction w arm pain

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33
Q

what is a commonly used med for injections

A

methylpredisolone

34
Q

what is part of the procedure for injections

A

fluoroscopy is used to guide the injection

35
Q

who may epidural injections be considered for

A

pts w cervical radiculopathy from degenerative disorders

36
Q

what is the main patient who will benefit from injections

A

someone w disc herniation + radiculopathy

37
Q

what does the evidence say about the the use of epidural injections for pts w chronic neck and UE pain

A

combo of pharmacotherapy, PT, and epidural may be more effective than either approach individually

38
Q

what pt is the evidence GOOD for a cervical epidural w local anesthetic and steroids

A

cervical disc herniation

39
Q

what does the literature say about the use of local anesthetic vs cervical epidural + local anesthetic + steroids only for cervical disc herniation

A

fair for use of local anesthetic only
- good for the other

40
Q

what pts is the evidence fair for use of local anesthetic (w or w/o steroids) - 3

A

axial or discogenic pain
spinal stenosis
post-surgery syndrome

41
Q

what is a consideration of the use of epidural injections

A

potential complications d/t invasive nature

42
Q

what are 4 indications of surgical intervention being needed

A
  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
Q

what are 2 anterior approach surgical procedures

A

ACDF - cervical discectomy w or w/o fusion

ACD (TDR) - disc arthroplasty (artificial disc)

44
Q

what are 3 posterior decompression surgical procedures

A

foraminotomy
laminaplasty
laminectomy

45
Q

what is a laminectomy

A

removal of vertebral lamina to decompress SC (w or w/o fusion)

46
Q

what is a laminoplasty

A

lamina is moved to expand space for SC

47
Q

what is a foraminotomy

A

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
Q

what are indications for a discectomy & what are the 2 strongest indications

A

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
Q

what does ACDF stand for

A

anterior cervical discectomy and fusion w anterior cervical plate fixation

50
Q

what are 4 types of materials used for an ACDF and what is the most typical

A

allograft bone
autograft bone
synthetic alternative
PEEK cage

most done w small ant plate w screws for stabilization

51
Q

what is the purpose of a plate in an ACDF

A

stabilize while bone heals

52
Q

how does the spine heal after an ACDF

A

bone fuses and becomes solid block of bone which allows for no motion

53
Q

what are typical precautions after an ACDF

A

lifting and activity restricted for first 6wks
**no traction or manip for 3 mo
**no joint mob near replaced segments

54
Q

what is the rehab focus post-op ACDF

A

ice to neck 10min up to 3x/day
walking program
deep neck strengthening and stability exercises

55
Q

what is the most important precaution after an ACDF

A

**no traction or manip for 3 mo
**no joint mob near replaced segments

56
Q

what are 3 common temporary sx post op ACDF

A

hoarseness
difficulty swallowing
dizziness

57
Q

when does PT start after ACDF

A

weeks 3-6

58
Q

what does PT in the hospital post ACDF look like

A

log rolling/posture
walking progression
cervical collar

59
Q

how long can it take for graft to heal post ACDF

A

up to 1yr

60
Q

rehab plan weeks 1-2 post ACDF (3)

A

progress walking & endurance
gentle AROM PAINFREE
no lifting >10#

61
Q

rehab plan weeks 2-4 post ACDF (3)

A

AROM R & L (may use 2 finger to provide assistance)
aerobic exercise - walking/UBE
deep neck ms strengthening - isometrics

62
Q

what is the goal of rehab weeks 4-12 post ACDF

A

return to PLOF

63
Q

rehab plan weeks 4-12 post ACDF (3)

A

progress lifting </= 10-30#
progress deep neck ms strengthening (multilimb, dynamic, etc.)
UE resisted exercise

64
Q

rehab plan 3-6mo post ACDF (2)

A

self progression on higher level activities
progress exercises

65
Q

why might a pt still have arm pain after an ACDF

A

can happen if disc was compressing nerve root for weeks
- lots of inflammation had formed and takes time to resolve

66
Q

what negative outcome is associated with spinal fusion seen in ACDF

A

adjacent segment dz

67
Q

why might someone develop a clinically significant disc dz at levels adjacent to fused discs in ACDF (3)

A

altered biomechanical stresses
surgical disruption of soft tissue
natural hx of cervical disc dz

68
Q

outcomes from an ACDF vs non-surgical management and what is the take away from this

A

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
Q

what is the significance of a Mobi C as an artificial disc device

A

bone sparing fixation

70
Q

what is the significance of a simplify disc as an artificial disc device

A

allows for use of MRI imaging

71
Q

what are 3 indications for cervical disc arthroplasty

A
  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
Q

what is a clinically symptomatic radiculopathy or myelopathy that would indicate the need for cervical disc arthroplasty

A

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
Q

what are 6 contraindications for a cervical arthroplasty

A
  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
Q

what is the main difference in the rehab protocol b/w ACDF and a disc arthroplasty and why

A

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
Q

why does disc arthroplasty heal faster than an ACDF

A

less invasion
no fusion to worry about

76
Q

what are the phases post a disc arthroplasty

A

phase 1: protection phase
- some restrictions wks 1-3
phase 2: intermediate
phase 3: advanced strengthening
phase 4: return to activity

77
Q

what are 4 pros of TDR vs ADF

A

better clinical outcomes
greater segmental motion
dec rate of subsequent surgeries
lower rates of adjacent segment secondary surgeries

78
Q

what is one con of TDR vs ACDF

A

longer term follow-up needed

79
Q

what is the timeline for PT post a TDR

A

might start PT at 2wks
unrestricted return at 4wks

80
Q

what are 3 pros of ACDF vs TDR

A

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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