L-Spine Post-Op Rehab [Guest Lecture]

Question 1

List the Most significant indications for imaging of the spine

Answer 1

Back pain in children < 18 yo

Severe pain if > 55 yo

Night pain

Marked morning stiffness

Severe restriction to motion

Loss of B&B function

Saddle paresthesia

Question 2

List the 2 surgical procedure performed inthe L-spine

Answer 2

Decompression

Fusion (limits motion)

Question 3

Describe the surgeon’s perspective on herniated lumbar discs

Answer 3

Most get better with time

Epidural injections may help

Surgeons think that PT will exacerbate sx but modalities may be helpful

Surgery is very sucessful is it’s performed on the right pt

Question 4

Describe the ideal herniated disc surgical candidate

Answer 4

Those with + SLR and imaging that matches their sx have 95% success rate

Extruded disc herniations seem to do better

Question 5

Procedure:

• 3 cm incision
• dissect mm away from bone
• laminotomy to access disc followed by disc removal

Answer 5

Discectomy

Question 6

Procedure:

• Smaller incision
• Less tissue dissection
• Nerve retractor to move SC and removal of disc material

Answer 6

Endoscopic microdiscectomy

Question 7

Describe the difference in pt. outcomes 1 year and 5 year s/p surgery vs. conservative tx

Answer 7

Year 1: surgery group did better

Year 5: no difference in group outcomes

Question 8

Describe why large uncontained herniations are more likely to spontaneously resolve

Answer 8

Due to exposure to the epidural blood supply phagocytosis can occur

Those that are small and contained are more likely dehydrated

Question 9

Describe the L-spine discectomy surgical candidate

Answer 9

• CE
• Severe motor deficit (1-2/5 w/in 3 months)
• No LBP
• NOT a degenerative condition

Question 10

Describe the L-spine conservative tx candidate

Answer 10

• Has directionaly preference
• Disc protrusion
• Annular disruption
• Mild to mod weakness
• Minimum 6 mo

Question 11

Describe the surgeons perspective on spinal stenosis

Answer 11

• Most common in 50+ yo
• May have hx of related leg pain
• SLR neg
• Rule out vascular claudication w/peripheral vascular exam
• Decompresison surgery

Question 12

List the surgical tx options for spinal stenosis

Answer 12

• Nothing: meds, bracing in slight flexion, activity modification
• Epidurals
• Surgery: laminectomy/decompression 80% successful

Question 13

List possible etiologies of spondylolisthesis

Answer 13

• Degenerative
• Fx
• Congenital
• Post surgical

Question 14

Condition: Pt. may have back pain, leg pain, or a combination of the two

Answer 14

Spondylolisthesis

Question 15

List the surgical tx options for sponylolisthesis

Answer 15

• Bracing, med, PT
• Epidural
• Decompression is grade 3 or 4

Question 16

Describe the direct complications of fusions

Answer 16

Decreases bone mineral density

Segmental instability above or below surgical level

Question 17

List the general precautions for spinal fusions

Answer 17

• Log roll, hips at bend of bed
• No hip flex > 90
• No twisting/bending/rotating/fwd bending/stooping
• No lifting > 5-10#
• No sitting > 30 min

Question 18

Describe the focus of inpatient acute rehab for post-op L-spine

Answer 18

• walking
• bed mobility
• transfers

Question 19

Term: How movement induces pathology

Answer 19

Kinesiopathology

Question 20

Describe the focus of early outpatient rehab for post-op L-spine

Answer 20

• Position of comfort (gives pt. sense of control)
• Funcitonal task