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Musculoskeletal Conditions II > Cervical, Thoracic, and Lumbar Spine Surgeries > Flashcards

Cervical, Thoracic, and Lumbar Spine Surgeries Flashcards

1
Q

Rates of spinal surgeries in the US are [30%/80%] higher than in the UK.

A

80% higher than the UK

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2
Q

Rates of spinal surgeries in the US are [30%/55%] higher than in the Netherlands.

A

30% higher than in the Netherlands

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3
Q

Rates of spinal surgeries in the US are [55%/80%] higher than in Canada.

A

55% higher than in Canada

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4
Q

T/F Zip code is not a significant predictor of low back surgery.

A

False, zip code is a significant predictor of low back surgery

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5
Q

What are the indications for lumbar spine surgery? (5)

A
  • Fracture/instability (fusion)
  • Radiculopathy that’s failed conservatively (herniated disc, DDD)
  • Recurrent radiculopathy
  • Cauda equina syndrome
  • Progressive acute myelopathy (distal pain, numbness, weakness, bowel/bladder)
  • Severe, incapacitating axial back pain that’s failed conservatively
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6
Q

T/F A mild foot drop is an absolute indication for surgery.

A

False, mild foot drop is NOT an absolute indication for surgery, and many will recover with nonsurgical treatment!

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7
Q

[Physical/Psychologic] factors may be the strongest predictors of LBP outcomes following surgery.

A

Psychologic factors

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8
Q

Is surgery recommended for most individuals with chronic non-specific LBP?

A

NO!

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9
Q

It is recommended that individuals should wait at least 1 year before surgery for LBP, what should be done during that year prior to surgery?

A

intensive rehab and CBT components

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10
Q

T/F Discectomy for lumbar radiculopathy has equivalent outcomes after 1-2 years as those not undergoing surgery.

A

True, but in the short term, discectomy has better outcomes

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11
Q

After __ to __ weeks of radicular symptoms, open discectomy or microdiscectomy could be considered.

A

6-12 weeks of radicular symptoms

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12
Q

T/F For spinal stenosis, long term follow up is equivalent to conservative care.

A

True, but surgery may help

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13
Q

When a serious condition isn’t suspected, what may imaging lad to? (4)

A

Increased (1) surgery, (2) opioid use, (3) procedures, and (4) prolonged recovery

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14
Q

T/F Spine imaging shows degenerative changes in asymptomatic people, even starting at age 20.

A

True, and the prevalence of the findings increase with age

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15
Q

When should imaging be ordered for LBP? (3)

A

(1) Clinical suspicion of serious pathology
(2) planning evidence-based intervention
(3) It is likely to change management

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16
Q

Describe to a patient what they need to know about imaging if they ask, “Do I need to get an MRI?”.

A
  • Most cases of LBP are simple strains and sprains of the back that, while painful and unpleasant, improve rapidly just like a sprained ankle.
  • Having an image (xray or CT or MRI scan) of your back does not usually help to find the cause of the back pain or guide treatment.
  • Treatment for most cases of back pain is the same whether imaging is used or not; and we have seen that those who have unnecessary imaging often have a delayed recovery.
  • Unnecessary imaging has some risks, including radiation exposure and delay in appropriate treatment, and has been associated with worse patient outcomes and an increase in unnecessary surgery.
  • You may know other people who have had an xray, CT, or MRI of their back that showed “changes”; but most of the changes seen on imaging are normal and are more common the older you get, just like grey hair and wrinkles. As these changes also occur in people without back pain, their relevance is unclear.
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17
Q

What are the broad surgical categories for the lumbar spine? (2)

A

(1) Radicular Pain Conditions: disc herniation and spinal stenosis with/without spondylolisthesis
(2) Nonspecific LBP: disc degenerative changes and facet degenerative changes

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18
Q

What are the names of the possible lumbar spine surgeries and procedures? (8)

A
  • Microdiscectomy
  • Laminectomy
  • Fusion
  • Intradiscal electrothermal therapy (IDET)
  • Artificial disc replacement
  • Radiofrequency neurotomy/ablation
  • Chemonucleolysis
  • MILD (Minimally Invasive Lumbar Decompression)
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19
Q

T/F Fusion surgery may be more effective than doing nothing for chronic LBP, but not better than CBT.

A

True, there was no disability difference from fusion and 3 weeks of CBT

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20
Q

What prognostic factors indicate that individuals will improve from a lumbar discectomy? (4)

A

(1) leg pain>back pain
(2) older age (>52)
(3) back pain >6/10
(4) higher SF-12 scores

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21
Q

What are the possible spinal injections? (4)

A

(1) epidural steroid injections: transforaminal or interlaminar
(2) facet joint block
(3) lumbar sympathetic block
(4) sacroiliac joint steroid injection

22
Q

The benefits from an epidural glucocorticoid injection for persistent radiculopathy are [short/long] term.

A

short-term

23
Q

An epidural glucocorticoid injection for persistent radiculopathy has potential to provide modest benefit with what? (2)

A

decreased pain and improved disability

24
Q

T/F Epidural steroid injections are evidence supported for acute radiculopathy, nonspecific LBP, and chronic LBP.

A

False, they are not supported for these!

25
Q

What complications can occur from lumbar injections? (7)

A
  • Anesthetic reactions
  • Allergic reactions to medicine
  • Bruising/bleeding at injection site
  • Nerve/spinal cord damage
  • Thrombophlebitis
  • Infection injection site, deep tissues, joint
  • Ongoing pain
26
Q

What complications can occur with lumbar surgery? (9)

A
  • Anesthetic reactions
  • Thrombophlebitis
  • Pulmonary embolus/edema
  • Major bleeding
  • Infection
  • Heart failure
  • Nerve damage (dural tear, cord damage)
  • Ongoing pain
  • Scar tissue formation
27
Q

The early complication rate for lumbar surgery is ___%.

A

17%

28
Q

With Failed Back Surgery Syndrome (FBSS):

____% will develop FBSS after surgery

2nd surgery ___% success rate

3rd surgery ___% success rate

4th surgery ___% success rate

A

4-50% will develop FBSS after surgery

2nd surgery 30% success rate

3rd surgery 15% success rate

4th surgery 5% success rate

29
Q

What factors affect spine surgical recovery? (6)

A
  • Movement & Alignment Factors
  • Extrinsic Factors
  • Psychosocial Factors
  • Physiological Factors
  • Expectations
  • Patient Selection
30
Q

Is high or low intensity exercise slightly faster in decreasing pain and disability following surgery?

A

high intensity

31
Q

Exercise starting __ to __ weeks post-surgery improves pain and disability.

A

4-6 weeks

32
Q

T/F ODI scores following 6-8 weeks of early PT do not improve.

A

True, at least in one study

33
Q

T/F A single 30 minute session of PNE prior to surgery can decreases medical expenses at 1-3 years follow up and improve satisfaction.

A

True, medical expenses decrease by 45% at 1 year and 37% at 3 years follow up

34
Q

Rehab after surgery should consider what factors? (4)

A

(1) tissue healing
(2) surgical procedure
(3) surgical stage
(4) surgeon recommendation

35
Q

What are the indications for thoracic spine surgery? (5)

A
  • Vertebral Fractures
  • Instability
  • Radiculopathy that’s failed conservatively (herniated disc, DDD)
  • Recurrent thoracic radiculopathy
  • Severe, incapacitating axial back pain that’s failed conservatively
  • Adolescent idiopathic scoliosis
36
Q

What are the vertebral fracture types? (3)

A
  • Flexion: Compression - osteoporotic; Axial burst – landing on feet
  • Extension: traction/MVA
  • Rotation: Transverse process; Fracture Dislocation
37
Q

What are the thoracic spine procedures? (4)

A

kyphoplasty, vertebroplasty, fusion, and multilevel fusion with Harrington rods (scoliosis)

38
Q

What are thoracic spine surgery complications? (5)

A
  • Anesthetic reactions
  • Thrombophlebitis
  • Infection
  • Nerve damage
  • Ongoing pain
39
Q

What are thoracic spine injection complications? (4)

A
  • Allergic reactions to medicine
  • Bruising/bleeding at injection site
  • Nerve/spinal cord damage
  • Infection injection site, deep tissues, joint
40
Q

What rehab should be considered for osteoporosis? (6)

A
  • Five-point Rehabilitation Program for Osteoporosis
  • Posture & body mechanics
  • Flexibility
  • Strengthening
  • Weight-bearing
  • Balance
41
Q

With a diagnosis of scoliosis, patients will have the following measurements:

(1) cobb angle of ___ degrees
(2) >___ degrees associated with curve progression
(3) >___ degrees associated with back pain

A

(1) cobb angle of 10 degrees
(2) >25 degrees associated with curve progression
(3) >16 degrees associated with back pain

42
Q

[Females/Males] are 5-10 times more at risk for severe scoliosis.

A

Females

43
Q

What are the possible cervical spine surgeries? (5)

A
  • Microdiscectomy
  • Laminectomy
  • Fusion
  • Corpectomy
  • Radiofrequency neurotomy
44
Q

What are the indications for cervical spine surgery? (6)

A
  • Fracture/instability (fusion)
  • Progressive cervical myelopathy (most often from stenosis)
  • Radiculopathy that’s failed conservatively (herniated disc, DDD)
  • Recurrent radiculopathy
  • Progressive neurologic deficit (distal pain, numbness, weakness)
  • Severe, incapacitating axial neck pain that’s failed conservatively
45
Q

What structures can be damaged during an anterior cervical discectomy and fusion (ACDF)? (5)

A
  • Carotid artery
  • Trachea
  • Esophagus
  • Laryngeal nerve
  • Pseudoarthrosis
46
Q

Following anterior cervical decompression and fusion (ACDF), patients were satisfied (80%) but still reported what? (4)

A

Decreased neck muscle endurance and QOL; increased mental illness; and daily neck pain

47
Q

What are the possible complications following cervical spine surgery? (5)

A
  • Anesthetic reactions
  • Thrombophlebitis
  • Infection
  • Nerve damage
  • Ongoing pain
48
Q

Asymptomatic cervical disc herniations may be as high as ___%.

A

81%

49
Q

What are the Wainner criteria for cervical radiculopathy? (4)

A

(1) positive upper limb tension test A(ULTTa)

(2) involved-side cervical rotation range of motion less than 60 degrees

(3) positive distraction test

(4) positive Spurling’s test A

50
Q

Cervical disc protrusions are found in __% of 45-54 year olds and __% of those 65+.

A

20% of 45-54 year olds and 57% of those 65+

51
Q

Those with cervical radiculopathy will see substantial improvements by __ to __ months and 83% see complete recovery by __ to __ months.

A

substantial improvements by 4-6 months and recovery by 24-36 months

52
Q

How can you educate the patient to “stay active”?

A

Educate with: red light green light, touch the wall don’t punch it, goldilocks principle, keep pain at a good level so that you can get back to a normal functioning level sooner and not have to deal with managing pain/getting rid of high amounts of pain (high irritability), etc.

Musculoskeletal Conditions II (20 decks)

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