Exercise After Back Surgery

Question 1

Pre-Op Management

Answer 1

-pain management
-full ROM
-Education (swelling, pain, precautions, AD)

Question 2

Post-Op Complications

Answer 2

-infection
-DVT/PE
-Delayed healing
-muscle function
-Nerve entrapment/dysruption
-scarring

Question 3

PEACE & LOVE

Answer 3

PEACE: Immediate care
-Protect, elevae, avoid NSAIDs, compression, educate

LOVE: management
-Load, optimism, vascularization, exercise

Question 4

Max Protection Phase

Answer 4

-0-6 weeks
-inflammation and pain
-Consider: WB status, bracing, light loading

Question 5

Mod Protection Phase

Answer 5

-4-12w
-more mobility, less pain
-restore normal ROM
-increase strength
-NM control

Question 6

Min Protection Phase

Answer 6

-6w to 1 y
-functional strength
-sport/function specific training

Question 7

Indications for Surgery

Answer 7

-Nerve involvement
-Failure of conservative management >3m

Question 8

Post-Op Spinal Precautions

Answer 8

BLT: Bending, lifting (10lbs) , twisting
-log roll
-sitting in car

Question 9

Lumbar Approaches

Answer 9

Posterior: Lamina
Posteriorlateral: Facet joint
Lateral: Pedicle
Anterior: Body

Question 10

Goal of Spinal Surgeries

Answer 10

-decompression
-relieve neuro s/s
-maintain inttegrity
-stabilize

Question 11

Laminectomy

Answer 11

-remove lamina and lig flava
-muscles resected (multifidi)

Phase I (0-3w):
-Bracing
-no exsessive ROM
-restore muscle activation
-dec pain
-walk, ADLs
-no bike until 3w

Phase II (3-8w):
-More of ^^
-postural endurance

Phase III (8-12w):
-loading the spine with good mechanics

Question 12

Microdiscetomy

Answer 12

-decompression without fusion
-only herniated portion of disc, lig flavum, inferior facet

Phase I (0-3w):
-Bracing
-no exsessive ROM
-restore muscle activation
-dec pain
-walk, ADLs

Phase II (3-8w):
-More of ^^
-no AROM flexion
-postural endurance
-no bike until 6w
-no sitting @90 deg

Phase III (8-12w):
-loading the spine with good mechanics

Question 13

Lumbar Fusion

Answer 13

-stop motion at certain segment of spine
-lamina removed, facets trimmed, disc removed
-implant inserted into disc space
-may have additional screws

Phase I (0-3w):
-Bracing
-no AROM
-restore muscle activation
-dec pain
-walk, ADLs

Phase II (3-8w):
-More of ^^
-postural endurance
-no AROM

Phase III (8-12w):
-loading the spine with good mechanics
-no ROM until 12w

Question 14

PLIF

Answer 14

-posterior lumbar interbody fusion
-multifidi, lamina, dura removed
-avoid lumbar rotation (lock out with legs to isolate rotation to the thoracic

Question 15

TLIF

Answer 15

-transfemoral lumbar interbody fusion
-posteriorlateral
-unilateral lamenectomy and inferior facetectomy (can be bilateral if issue controlling)
-less muscle trauma

Question 16

ALIF

Answer 16

-anterior lumbar interbody fusion
-allows access to ventral disc
-allows full discectomy and direct implant insertion
-less painful, less muscle damage

Complications:
-visceral injury
-vascular injury
-larger scar
-retrograde ejaculation

Question 17

Long Term Effects

Answer 17

-degeneration in adjacent levels
-increased forces on disc due to decrease in facet and lamia space (shift in axis of rotation posteriorly)

Question 18

Disc Replacement

Answer 18

-decompression with motion preservation
-not meant for stabilization, ankylosing spondy, spondylolisthesis, hypertrophic facets
-only relieves that level

Question 19

Post- Surgical Considerations

Answer 19

-disc hydration/dehydration
-changing positions often
-avoid stretching and rotation at lumbar
-avoid prone
-healing times