L7 Surgical Management of Spine Flashcards
indications for surgery of spine
cauda equina syndrome
neuro loss such as drop foot
irretractable pain
anatomic lesion well correlated to symptoms
failed conservative care
indications for immediate surgical intervention
severe, intractable pain
significant neuro deficits like cauda equina
discectomy
removal of disc material
laminectomy
removal of bone to address stenosis
decompression
fusion spinal surgery
address spinal instabiliy
laminotomy and discectomy basic procedure
remove portion of bone over nerve root and disc material from area to relieve impingement and leave room for healing
muscles lifted not cut
indication for laminotomy and discectomy: what is it best for?
leg pain, not best for LBP
complications of disc herniation surgery
recurrent disc herniation: due to open hole in disc
pain return in 6 weeks
nerve injury
rehab for discetomy timelines
light work: 2-4 weeks
no bending or lifting: 4-6 weeks
sports: 2-3 months
6-8 weeks of PT
laminectomy: basic procedure
2-5in incision midline
dissect erector spinae off lamina
remove lamina and trim bone to give room for nerve roots
complications of laminectomy
recurrent symptoms due to degeneration after several years
laminectomy rehab
hospital 1-2 days
drive: 1-2 weeks
light work: 4 weeks
heavy work/sport: 2-3 months
fusion is most effective for how many segments?
one
posterolateral gutter fusion procedure
bone graft from pelvis
attach to TPs and muscles hold in place
bones set in 3 months, strengthen over 1-2 years
can also be done posteriorly/anteriorly/lateral into disc space
complications from hardware of spinal surgery
new/worse leg pain from hardware in wrong spot
psuedoarthritis from improper healing
adjacent level movement
proximal junction kyphosis
adjacent segment to fusion falls forward resulting in kyphosis
don’t try to correct into erect posture!
total disc replacement
new alternative to spinal fusion with decreased rehab time and decreased impact on load and movement of adjacent segments
indications for total disc
severe, chronic, disabling back pain at one or two levels with DDD
failed 6 months conservative treatment
total disc contraindications
facet arthropathy
OP
end plate irregularities like schmorls nodes
instability
spinal deformity
general post op protocol for spinal surgery
early pt return to max function
reduce pain
limit scar tissue formation
maintain dural mobility
rehab lumbar paraspinal muscles
fusion rehab
goal to successfully join vertebrae with callus over 6-8 weeks
1-5 days: pt edu, nerve mobilization, home care, bed mobility, ADLs, gait training
6-10 weeks: referred to OP PT at 6-8 weeks after callus forms for stabilization and reconditioning
11-19 weeks: return to work, weights
20 wks-1 year: restore pre injury status
disc replacement rehab protocol
recovery 0-4 weeks
corset 6 weeks
avoid sitting for more than 15-20 min, increase gradually
avoid extremes of flexion/extension/rotation
rehab 4-20 weeks graded lifting, aerobic, stability
don’t lift more than 12 kg for 12 weeks
don’t resume heavy works/sports for at least 3 monthsc
complications of spinal fusion
nerve injury
dural tear
epidural hematoma
infection
persistent pain, N/T
fusion complications
non union
PJK
dural tear s/s
positional headache
fluid in wound
clear fluid leaking from the patient’s back
delayed presentation
