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Musculoskeletal PT 2 > Common Lumbar Surgical Procedures > Flashcards

Common Lumbar Surgical Procedures Flashcards

1
Q

Describe the degernative cascade

A
  • phase 1: circumferntial tears
  • phase 2: radial/HNP tears
  • phase 3: spondlyosis/stenosis
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2
Q

Microdisectomy incidence of procedure

A
  • removal of bulging portion
  • 90% of all spinal surgeries involved DDD
  • 90% of all lumbar Herniated Nucleus pulpus occur at L4-5 and L5-S1 level
  • microdisectomy is gold standard for HNP with radicular symptoms
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3
Q

What are strong indications for having a microdisectomy

A
  • bowel and bladder invovlement
  • progressive neurological deficits
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4
Q

What are the relative indiciations for

a microdisectomy

A
  • more of an elective procedure
  • failure to respond to an active rehab program for 6 weeks
  • severe, incapaciting pain that eludes pain control
  • recurrent episodes of sciatica
  • significant neural deficits (+SLR less than 30)

Cross over SLR => go to uninvolved side and do a SLR (sciatic neural tension) and a positive result is symptoms down the other leg

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5
Q

What is the goal of a microdiscectomy

A
  • decompress nerve root
  • minimize scar formation that could bind down the nerve
  • avoid iatrogenic nerve damage
  • typically discharged same down/next day
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6
Q

Microdiscectomy procedure

A
  • goes down to the lamina
  • ligamentum flava is cut
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7
Q

What is an annulus repair with a microdiscectomy

A
  • reduced reoccurrence rate with sutured repair
  • concern is suture may now irritating the nerve root
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8
Q

Bone Anchored ACD

Annular Closure Device

A
  • plugs the breech of annulus
  • prevents reoccurance of disc bulging
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9
Q

Post op rehab overal goals with microdiscectomy

A
  • reduce pain (happens almost immediately)
  • prevent reoccurence
  • Controled motion with avoiding end range flexion
  • maintain dural mobility (dont want to scar down the nerve)
  • improve function
  • safe, early return to functional activities
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10
Q

Microdiscectomy outcomes

A
  • 90-95% success rate
  • smaller incision does not reduce hospital stay
  • 25% persistent pain with repeat surgery
  • better short term outcomes

keep in mind that in most people the disc couldve reaborbed over time

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11
Q

Potential complications of microdiscectomy

A
  • inadequate decompression
  • iatrogenic injuries
  • post op infections
  • reoccurence of herniation
  • impaired multifidii recovery
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12
Q

Percutaneous Endoscopic lumbar discectomy (PELD)

A
  • newer procedure
  • smaller incision
  • less muscule trauma
  • less post-op soreness
  • better outcomes

however

  • surgeon’s visual of herniation is more difficult
  • more expensive tools, increase cost of procedure
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13
Q

Lumbar fusions incidence

A
  • 137% increase in lumbar fusions performed
  • typically with stage 3 patients
  • average age is 52
  • male = female
  • 2-3 days average hospital length of stay
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14
Q

lumbar fusions indications

A
  • severe disabiling back or leg pain (2nd pahse of DDD)
  • post-traumatic instability
  • spondylolesthesis
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15
Q

Goals of

a lumbar fusion

A
  • successful unions of two or more segments
  • preserve lordosis
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16
Q

Posterior fusion

approach

A
  • SP and lamina are removed
  • pt can donate bone graft from iliac crest
  • 6 screws and 2 rods
  • go through pedicle into bodies
17
Q

Procedures for fusions

interbody fusion

A
  • clears out disc => threads the screws to provide a spacer
  • packed with bone graft = bone grows through perforation
18
Q

Fusions procedures

PEEK lumbar interbody cages

A
  • cage can be put in anteriorly or posteriorly
  • if cage is in by itself they must be immobilized
19
Q

potential complications of lumbar fusions

A
  • non-union rates up to 50% (bone doesnt take = more stress on hardware)
  • long term donor site pain up to 30%
  • accelerated adjacent level degeneration
  • iatrogenic cauda equina injruy 0.2-1%
  • impaired multifidii recovery
  • fusion will accelerate degeneration above and below
20
Q

Fusion outcomes

A
  • stand-alone ALIF demonstrated a shorter operative time and less blood loss
  • hospitalization time reduce with ALIF compared to TLIF
  • patient reported outcome measures were equal with ALIF or TLIF
  • VAS and ODI scores mainly favoured ALIF over PLF
  • adverse events were equal between ALIF and posterior fusion approaches

TFIL= Transforamenal lumbar interbody fusion

21
Q

Total posterior spinal arthroplasty (TOPS)

A
  • non-rigid fusion without bone graft
  • objective: stabilization with adjacent site perservation
  • allows movement but primary there for stabilizer and spacer
  • two titanium plates connected by a polycarbonate urethane boot
  • SP is removed and pedicle screws are used to anchor
22
Q

lumbar total disc arthroplasty

what does it do

A
  • maintain disc space
  • perserves motion
  • mid-term outcomes equal rigid fusion
  • must exceed gold standard
  • FDA approaved Charite disc in 2004
  • prodisc 2006
23
Q

Outcomes

lumbar total disc arthroplasty

A
  • prodisc-L is safe and effective treatment for chronic back pain caused by lumbar DDD as assessed at more than 5 years post-op
  • however outcome scores were slightly though significantly lower at last follow up visits than at 1 and 2 years post op
24
Q

what is lookin to happen in the future: molecular biology

A
  • cell based tissue replacement
  • re-grow chondroblast and fibroblast for disc injeciton

Musculoskeletal PT 2 (25 decks)

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