Exam 3 - Spine Flashcards
function of intervertebral discs
separate the vertebrae
absorb shock for the spine
cause of intervertebral disc disease (IDD)
deterioration, herniation, other dysfunction of the ID
becomes bone on bone
where is IDD most commonly seen
cervical spine but can affect thoracic and lumbar
IDD can occur as a normal ___ process
aging
degenerative disc disease changes can cause
OA
herniated disc
spinal stenosis
results of nucleus pulposus pushing through crack in annulus fibrosis
herniated disc
disc herniation commonly occurs
C5-6
C6-7
L4-5
L5-S1
*lumbar is most frequently affected
L3-4 pain area
back to buttock to posterior thigh to inner calf
L4-5 pain area
back to buttock to dorsum of foot and big toe
L5-S1 pain area
back to buttock to sole of foot and heel
space around the spinal cord narrows placing pressure on cord and nerves
spinal stenosis
non-op pain therapy
meds complementary alternatives good body mechanisms back strengthening exercises restricted activity ice, heat application PT
meds to reduce spinal pain
NSAIDS muscle relaxants anticonvulsants antidepressants epidural corticosteroid injections
purpose of spinal surgery
take pressure off the nerve
what is a laminectomy
removes lamina - back part of the vertebrae, covers spinal canal
purpose fo laminectomy
relieve pressure on spinal cord or nerves
laminectomy is usually out pt but may require a hospital day of what duration
1-3 days
most common treatment for ruptured or herniated disc
discectomy
performed for an unstable spine
spinal fusion
*adjacent vertebrae fused together with bone graft; metal, rods, plates, screws may be used
how to reposition a pt after a laminectomy, discectomy, fusion
log roll
pillow placement if supine after laminectomy , fusion, and disectomy
under knees
pillow placement if lateral after laminectomy, fusion, and disectomy
between legs
laminectomy postop assessments
neurological assessment
maintain proper spine alignment
limit lifting, bending, stooping for several months
back brace
monitor for complications
may return to work within a few week depending on job
discectomy post op assessment
neurological assessment maintain proper alignment limit lifting, bending, stooping back brace monitor for complications encourage walking return to office 2-4 weeks return to manual labor 4-8 weeks
postop infusion assessment
neurological maintain proper alignment longer healing time assess donor site (if present) no twisting, bending, stooping, lifting immobility at fusion site do not sit or stand for long periods of time rigid back brace firm mattress or bed board
preferred method of continuous pain management
PCA
PO pain control
tylenol + codeine hydrocodone oxycodone diazepam pregabalin
postop complications
CSF leak neuro impairment paralytic ileus bladder impairment bleeding
CSF leak s/sx
severe HA, worsens with rising
clear, yellow drainage
*notify provider ASAP
