Chapter 43 Spinal Flashcards
Describe acute pain.
due to trauma or injury. Muscle strain or spasm, ligament sprain or disc degeneration/herniation - less than 3 months
What is a herniated disc?
nerve pressure ( usually sciatic nerve- burning, stabbing, radiating pain)
What is a spinal stenosis>
narrowing of the spinal cord or nerve root
What is spondyloisthesis?
Defect in one of the vertebrae
What is Spondylolisthesis
vertebrae slips onto the one below itself
What is spondylosis?
degenerative changes in the spine
How do you assess for lower back pain?
pain, mobility, paresthsia (tingling), urinary and bowel incontinence
Describe interventions for acute lower back pain.
Position (Williams); Frequent position changes
Medications: NSAIDs acetaminophen, opioid/non opioid, analgesics, steroids
Epidural-corticosteroid/anesthetic
Describe interventions for chronic lower back pain.
Antidepressants
Heat/cold application
PT
Weight restrictions
What is phonophresis?
topical drug and 10 minutes of ultrasound (provided by PT)
What is lontophoresis?
toical drug and electrical current (provided by PT)
Describe surgical management for lower back pain
Minimally invasive
Patients will go home the same day
Conventional open- discectomy, laminectomy, fusion (p. 889)
What are some post-op considerations for lower back pain?
Conventional surgery- first 24-48 hours are the most critical
VS (fever& hypotension may indicate bleeding and pain)
Neurologic assessment
Ability to void
Pain ( PCA/ Oral medication)
Drains/ drainage (clear drainage usually indicates meningeal tear. Patients with meningeal tear and CSF leak are placed in a supine position and strictly on bed rest. Notify physician immediately if you suspect a CSF leak.)
Moving/mobility
VTE prevention
Explain failed back surgery syndrome (FBSS)
Usually due to the combination of organic, psychological and socioeconomic factors
Nerve blocks/ spinal cord stimulators
Repeated surgery
Intrathecal (spinal) injections with Ziconotide (Prialt)- N-type calcium channel blocker.
Describe cervical neck pain.
Often due to bulging or herniated disc. (nerve compression)
Radiating pain
Contributing factors: aging, poor posture, lifting, tumors, rheumatoid arthritis, osteoarthritis, infection
Describe nonsurgical pain management for cervical neck.
Position
Medication
PT
Describe surgical management (anterior and posterior approach) for cervical neck pain management.
Postoperative management : airway, breathing, circulation
VS; bleeding/drainage; swallowing; I&O
Ability to void
Pain
Mobility
What are some cervical neck pain surgical complications?
Hoarseness Dysphagia Esophageal, tracheal or vertebral artery injury Wound infection CSF leak Hardware problems
What is a complete spinal cord injury?
there is no innervation below the injury
What is an incomplete spinal cord injury?
some function or movement belove thw injury is present
List the primary injuries
hyperflexion hyperextension axial loading rotation injuries penetrating injuries
What is hyperflexion mechanism of injury
extreme flexion of the neck; car accidents; injury to thorax and lumbar spine if due to fall on buttocks.-primary
What is hyperextension mechanism of injury
rapture of longitudinal ligament- primary
What is axial loading mechanism of injury?
vertical compression (vertebrae shatters) primary
What are the secondary mechanisms of injury?
Hemorrhage Ischemia Hypovolemia Impaired tissue perfusion Local edema
Describe an assessment for spinal cord injury.
History
Airway; Breathing; Circulation (Cardiovascular and respiratory assessment)
Airway may be compromised; C3-5 controls breathing; pulse, BP, bleeding
Level of Consciousness (Glasgow coma scale)
Spinal shock
Sensory assessment
GI & GU assessment
What are some interventions for SCI?
Airway and breathing Intubation Coughing, pulmonary hygiene and suctioning Neurogenic shock Maintain hydration Monitor blood pressure (VS) Preventing secondary injuries Immobilization Body alignment Motor function & pain
What are some interventions for SCI?
Pressure ulcers Frequent position change Surgery To stabilize the spine Urinary and bowel elimination Foley catheter Intermittent emptying Stool softeners Increased fluid intake
What are some drug therapy for SCI?
Dextran- plasma expander Atropine sulfate – bradycardia tx Dopmine – hypertension Tizanidine- skeletal muscle relaxant Celebrex- heterotopic ossification Calcium & phosphate- prevent osteoporosis
Autonomic Dysreflexia
know :) It is the idea that you could be sitting on a tac and a paralyzed patient may not recognize it but the body will and will respond by a shooting blood pressure. Caused by bladder, bowel, skin irritation
What is a extramedullary spinal cord tumor?
within the spinal dura but not in the spinal cord
What is the assessment for a spinal cord tumor?
Pain- Radicular
Mobility –weakness, clumsiness, hyperactive reflexes
Sensory perception
Bladder and bowel weakness
What is an intramedulliary spinal cord tumor?
within the spinal cord central gray matter
What are some interventions for spinal cord tumors?
Surgery to relieve pressure and control symptoms
Postoperatively: monitor VS, neurologic function, CSF leak
Radiation- spinal cord can not tolerate high doses of radiation
Overexposure manifestations even 6-12 mts post therapy
Chemotherapy – limited options
Describe multiple sclerosis.
Inflammation which causes demyelination and axonal injury
Demyelination – slow or stopped impulses
Characterized by periods of remission and exacerbation
What are the 4 major types of MS?
Relapsing- Remitting type
Primary Progressive
Secondary Progressive
Progressive Relasping
What is relapsing remitting type of MS?
classic type. Symptoms develop and resolve with in few weeks or months
What is primary progressive MS?
Progressive neurologic deterioration without remission
What is a secondary progressive MS?
starts as relapsing/remitting but it gets progressively worst
What is progressive relapsing MS?
frequent relapses with partial recovery
What is the assessment for MS?
Presents as neurologic disease. Patients are often stiff and fatigued. Fatigue is very specific and disabling (sensitivity to temperature) Flexor spasm Hyporective reflexes Positive Babinski(toes curled outward) Unsteady gait Intention tremor (tremor with activity) Dysmetria Vertigo Speech problems
What are some diagnostic tests for MS?
No specific test
MRI
CSF- increased protein & WBC
CSF- IgG presence
What are some interventions for MS?
Interventions: Mainly pharmacological (p 908) PT Promote mobility Psychotherapy
Describe Amyotrophic Lateral Sclerosis- Lou Gehrig’s Disease.
Adult onset
Upper and lower motor neuron disease
Progressive weakness and muscle wasting
Leads to paralysis
Affects the ability to talk, swallow, breathe
Unknown cure
Negative prognosis (death occurs with in 3 years of diagnosis)
Unknown cause
May be due to the combination of genetic, viral and environmental factors
What is the assessment for Lou Gehrig’s Disease?
Fatigue
Muscle atrophy & Weakness
Motor & Cognitive changes
What are the interventions for Lou Gehrig’s disease?
PT & OT
Palliative Care
Speech therapy
Riluzole (Rilutek)
