Lecture 3

Question 1

What is different above PEACE+LOVE and RICE

Answer 1

No more Ice recommended

Question 2

PEACE and LOVE stands for….

Answer 2

Immediate care:
Protection
Elevation
Avoid Anti-inflammatories
Compression
Education

Care for later:
Load
Optimism
Vascularization
Exercise

Question 3

What takes the longest to heal? (for this class, other classes say other things)

Answer 3

Grade 3 ligament tear, ligament grafts

Question 4

What is the time frame of the maximum protection phase

Answer 4

immediately after surgery up to 6 weeks

could have immobilization or WB status, bracing, or loading restrictions

Question 5

What is the timeframe of the moderate protection phase of healing

Answer 5

4-12 weeks

goal: return full pain free ROM

Question 6

What is the time frame of the minimum protection phase?

What is the goal?

Answer 6

6 week to 12 month

restore functional strength, sports specific training

Question 7

What are indications to surgery

Answer 7

Absolute indication: Cauda Equina
Acute los of function: Foot Drop
Failure of conservative treatment for 3 months

surgery is better for loss of function than it is for pain

Question 8

What are BLT precautions

Answer 8

No bending

No lifting (over 10lbs)

no twisting

Question 9

Can patients with BLT precautions still bend to get things from floor?

Answer 9

Yes if they’re only hinging at the hips

Question 10

What is cut in a laminectomy?

Answer 10

Ligamentum Flavum often resected

muscle retracted

part of lamina removed

Question 11

Decompression without fusion (microdiscectomy)

Answer 11

Detact lateral attachment of flavum ligament from lamina

laminotomy preformed to remove osteophytes

attempt to decompress nerve root, may cut some protruding disc and remove loose disc fragments

Question 12

What muscle is generally problematic after being resected due to back surgeries

Answer 12

multifidus

Question 13

What are the general precautions for a laminectomy

Answer 13

no BLTs

Question 14

Rotation increases ________ in the lumbar spine, so be careful with these exercises with post-op patients

Answer 14

compression

think: Lumbar trunk rotations, rotational stretches

Question 15

When a patient gets a microdiscectomy do they have their lamina removed?

Answer 15

no, just a laminotomy

Question 16

What kind of precautions do lumbar fusion patients have

Answer 16

no BLTs

no active ROM for 12 weeks

more aggressive precautions for fusion than for laminectomy

Question 17

What happens in a posterior lumbar interbody fusion (PLIF)

Answer 17

Bilateral Muscle strip dissection (Multifidi)

Laminotomy

Dura is retracted

Spacer is inserted between endplates

Question 18

How does the transforaminal lumbar interbody fusion (TLIF) compare with the PLIF.

Answer 18

approach is more posteriolateral for TLIF

Unilateral laminectomy

less muscle trauma, reduced injury to ligamentum flavum

surgery is often done bilaterally if they cant control motion in that segment

Question 19

What are the benefits to the Anterior lumbar interbody fusion (ALIF)

Answer 19

allows better access to entire ventral surface of disc, allows for comprehensive discectomy and direct implant insertion

Question 20

What is adjecent segment degeneration

vs

Adjacent segment disease

Answer 20

High incidence, radiographic changes of adjacent segments after a surgery REGARDLESS OF SYMPTOMS

Lesser incidence, “disease” is only when adjacent segment causes symptoms

Question 21

After surgery, altered biomechanics cause changes in the center of rotation

how does this affect the forces through the disc

Answer 21

increased forces and compression on IVD, up to 45% more

Question 22

What is a decompression with motion preservation (disc replacement)

Answer 22

for single level of disc dysfunction (can be multiple levels)

not intended to stabilize spinal column

Question 23

When are disc replacement surgeries contraindicated

Answer 23

Hypertrophic facet joints

translational deformities (spondylolithesis)

Contraindicated in segmental autofusion (ankylosing)

Caution in those with poor bone quality

Question 24

what are 5 considerations for post-surgical managment

Answer 24

1. disc hydration
2. change position every 15-30 mins
3. avoid stretching/rotation of lumbar
4. avoid lying prone/flat
5. think about healing times

Question 25

all motions of the sacrum are very __________

Answer 25

small

Question 26

what SI joint ligament provides the most stability

Answer 26

interosseus ligament

Question 27

Sacral nutation means what?

Answer 27

flexion of sacrum

Question 28

What sacrum motion occurs during standing/ landing

Answer 28

Sacral nutation

Question 29

What motion happens at the sacrum with lordosis positions or with spinal extension which increases lumbar lordosis

Answer 29

sacral nutation

Question 30

What happens at the sacrum when both innominates rotate posteriorly

Answer 30

sacral nutation

Question 31

What motion happens with anterior rotation of both innominates

Answer 31

Sacral counternutation

Question 32

what sacral motion occurs with spinal flexion ( decreased lumbar lordosis)

Answer 32

Sacral counternutation

Question 33

When does counternutation become an issue in the spine?

Answer 33

when the lumbar spine flexes but the sacrum doesnt move

Question 34

Inflare of the innominate happens with ___________

outflare of the innominate happens with ___________

Answer 34

hip internal rotation

external rotation

Question 35

Innominate anterior rotation happens with hip ____________

Innominate posterior rotation happens with hip _______________

Answer 35

extension

Flexion

Question 36

What kind of innominate rotation will happen in SLS

Answer 36

Posterior rotation of innominae