C-Spine Post-Op Rehab [Guest Lecture]

Question 1

Describe the amount of rotation that occurs between C1-C2

Answer 1

50% of rotation

Question 2

Describe the red flag indications for c-spine surgery

Answer 2

• Fx: major trauma [in osteopenia pts.]
• Myelopathy that is progressive
• Neoplasm (> 50 yo, WL/WG)

Question 3

Condition

• Sensory distrubances in hand
• Intrinsic mm wasting of hand
• Unsteadiness during walking
• Hyperreflexia

Answer 3

Myelopathy that has progressed to the point where surgery would be indicated

Question 4

Describe the main surgerical types and approaches in the c-spine

Answer 4

Decompression or fusion

Anterior (preferred) or Posterior

Question 5

List the Adv and Disadv of the posterior approach

Answer 5

Adv: superior for lateral herniations, safer for bone spurs pt., avoids fusion

Disavd: w/o fusion allows for continued disc collapse/pressure, may re-herniate, more technically difficult

Question 6

Describe when surgery would be recommended for pt. with cervical radiculopathy

Answer 6

• Failure of conservative management has after at least 2-3 months
• Progress of neuro dysfunction, esp. weakness
• Persistent numbness, esp. in dominant hand

Question 7

Condition:

• UE/LE weakness
• B&B dysfunction
• Gait disturbance
• Due to cord compression

Answer 7

Cervical myelopathy

Question 8

List the conditions where surgery is the first approach for the plan of care

Answer 8

• cervical myelopathy
• tumor
• infection
• trauma

Question 9

List the potential complications following cervical disc replacement

Answer 9

• Periprosthetic ossification
• Migration: anteriorly or posteriorly

Question 10

List the General rules for the acute stage for a post-op c-spine

Answer 10

• Brace/collar for fusion pts.
• NO ROM
• Keep HOB up
• No lifiting > 5-10#

Question 11

Describe the focus of the acute phase for post op c-spine

Answer 11

• bed mobility
• ambulation
• stairs

Question 12

Describe the focus of outpatient rehab for post-op c-spine

Answer 12

• Precision of movement vs. total ROM
• Posture in daily activities
• alignment of shld girdle

Question 13

Muscle impairment:

Compromise of fine control

Translation over sagittal rotation

Answer 13

Intrinsic neck mm have become weak or long

Question 14

Muscle impairment: Addingn compressive, rotational, and shear forces

Answer 14

Extrinsic neck muscles become dominant

Question 15

Describe the effect of slumping

Answer 15

• Increased thoracic curve
• Increased cervical lordosis
• Long anterior flexors
• Short/stiff posterior extensors

Question 16

Describe standard shld girdle alignemtn

Answer 16

• Scapula between T2-7
• Abd 3-4’ from spine
• Slight IR
• Slight anterior tilt