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MSK 2 > Amy Hay--Cervical Surgery > Flashcards

Amy Hay--Cervical Surgery Flashcards

1
Q

Surgical Procedures

A
  • Decompression
  • Discectomy w/ Fusion (ant/post)
  • Discectomy plus Corpectomy
  • Post Laminectomy
  • Artificial Disc

Intractable Pain

  • Spinal Cord Stimulator
  • Intrathecal Pump
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2
Q

Cervical Disc Surgery Patient Selection

A
  • Progressive/non-improving motor deficits
  • Failure of PT and interventional pain management
  • Spinal cord (spasticity/weakness LE, Numbness UE/LE, Weak legs, increased reflexes in LE)
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3
Q

Cervical Prolapse

A

Age: 25-45
S/Sx: reflex change, numbness, +foraminal compression test, +axial separation test, sagittal motions worst; partial/complete dermatome

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4
Q

Acute Cervical Extrusion

A

Age: 25-45

  • Arm worse than neck pain
  • severe broad radiating pain in UE
  • All motions limited/pn
  • neurological changes
  • Negative axial separation test (can’t completely alleviate with axial separation/may increase Sx)
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5
Q

Anterior Cervical Discectomy

A
  • Indication: disc pathology with nerve/spinal cord involvement
  • procedure one level Sx
  • Structures Affected: ALL, disc, foramen
  • Go in anteriorly
  • common with fusion
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6
Q

Discectomy Patients

A
  • Conservative
  • controlled mobility
  • longus colli work
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7
Q

Advantages of Ant Discectomy and Fusion

A
  • restore height
  • open foramen
  • decrease ligament buckling
  • control segmental motion
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8
Q

Anterior Discectomy, Corpectomy, Fusion

A
  • Corpectomy=removal of vertebral body (rare)
  • Indications: bony stenosis with myelopathy
  • Tissues affected: ALL, Disc, Vertebral Body, PLL
  • Longer healing, up to 3 months neck brace
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9
Q

Posterior Discectomy

A
  • Indications: disc herniations near spinal nerve (more lateral)
  • position in prone and flexion
  • Structures Affected: Lamina, Ligamentum Flavum, Nerve Root, Disc, muscles
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10
Q

Manual therapy with Corpectomy with fusion

A

Conservative (>12 weeks)

can do soft tissue

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11
Q

Advantage/Disadvantage of Post Discectomy

A
  • Adv: don’t have to fuse

- Disadv: no increased segmental height for nerve root (3-5% chance recurrence)

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12
Q

Posterior Discectomy & Fusion

A

Indications: disc disease, fractures

-Combined with other procedures (laminotomy, discectomy, foraminotomy)

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13
Q

Post Laminectomy

A
  • Indication: spinal stenosis & myelopathy
  • Goal: remove lamina to give cord more room
  • Often with fusion
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14
Q

Cervical Disc Replacement Indications

A
  • neck/arm pain due to disc pathology
  • no significant facet joint disease/bony compression on nerve
  • no prior major CS surgery
  • No deformity (scoliosis)
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15
Q

Advant/disad Disc replacement

A

-Adv: improved mobility, no increased stress on adjacent segments, no need of bone graft

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16
Q

Disc replacement

A
  • anterior approach
  • metal or metal/plastic combo
  • improved neurological function
17
Q

Tx for intractable spinal pain

A
  • Spinal Cord Stimulator

- Intrathecal Pump

18
Q

Spinal Cord Stimulator Indications

A
  • Failed neck surgery
  • Severe nerve related pn/Numbness
  • CRPS
  • Successful percutaneous trial
19
Q

Spinal Cord Stimulator

A
  • Implantable system that sends electrical pulses to dorsal spinal cord
  • inhibits pain signals
  • pt has tingling sensation
  • laminotomy to place leads with slack to allow spinal movements
  • helps with extremity pain (not as much with spinal pn)
  • have paresthesia instead of pain
20
Q

Spinal cord stimulator post op considerations

A
  • no bending fwd, heavy lifting/straining for 6 weeks
  • no reaching overhead, bend, twisting for 6 weeks
  • resume light to normal activity 1-2 days
  • walk as much as pain allows
21
Q

Intrathecal pump Indications

A
  • conservative therapy failed
  • no benefit from additional surgery
  • dependent on pain meds
  • no phychological problems
  • no medical conditions that would keep pt from undergoing implantation
  • not allergic to drugs in pump
  • +response to trial dose of meds
22
Q

Intrathecal Pump

A
  • gives meds directly to spinal cord placed under skin in abdomen
  • direct delivery of smaller doses
  • can use multiple meds (pn, numbing, Mm relaxers)
23
Q

Common Cervical Interventional Procedures

A
  • trigger point injections
  • epidural steroid injections
  • epidural lysis of adhesions
  • facet (injections, medial branch blocks, radiofrequency ablation)
  • c0-1 & C1-2 joint injections
  • sympathetic block (stellate ganglion)
24
Q

3 Most Common Procedures

A
  1. Ant discectomy with fusion
  2. post discectomy with fusion
  3. laminectomy with fusion
25
Q

Percutaneous Adhesiolysis Indications

A

-chronic arm/neck pain from:
-failed neck surgery
-spinal stenosis
-disc herniation >6 months
-Intermittent/continuous pn causing functional disability
-Fail to respond to non-interventional/non-surgical
Absence of facet joint pain

26
Q

Cervical Facet Pain

A
  • parasagittal neck pain
  • no arm pn, no midline pn
  • pn does not cross midline
27
Q

Cervical facet Synovitis

A
  • parasagittal neck pn
  • no arm pn
  • most pn with rotation
  • no large limits of motion
  • no pn with extension with chin-tuck
  • most pn with coupled 3D patterns
28
Q

Medial Branch Block

A
  • pt must be instructed to try activities that they are limited that same day to determine effectiveness
  • insurance may require series of 3 MBB prior to RFA
29
Q

Radiofrequency Ablation

A
  • AKA radiofrequency thermal coagulation
  • AKA radiofrequency denervation
  • Application: heatet, pulsed
30
Q

Headaches

A
  • Suboccipitals
  • Arthropathy
  • C0-1 or C1-2 Joint arthropathy
  • C2 Nerve root/DRG
  • discogenic
  • Disc segment (N root irritation)
31
Q

Nerve Blocks for HA

A

C2
Gr. Occipital N
Lesser Occipital N

MSK 2 (16 decks)

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