Lecture 3 Flashcards
What is different above PEACE+LOVE and RICE
No more Ice recommended
PEACE and LOVE stands for….
Immediate care:
Protection
Elevation
Avoid Anti-inflammatories
Compression
Education
Care for later:
Load
Optimism
Vascularization
Exercise
What takes the longest to heal? (for this class, other classes say other things)
Grade 3 ligament tear, ligament grafts
What is the time frame of the maximum protection phase
immediately after surgery up to 6 weeks
could have immobilization or WB status, bracing, or loading restrictions
What is the timeframe of the moderate protection phase of healing
4-12 weeks
goal: return full pain free ROM
What is the time frame of the minimum protection phase?
What is the goal?
6 week to 12 month
restore functional strength, sports specific training
What are indications to surgery
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
What are BLT precautions
No bending
No lifting (over 10lbs)
no twisting
Can patients with BLT precautions still bend to get things from floor?
Yes if they’re only hinging at the hips
What is cut in a laminectomy?
Ligamentum Flavum often resected
muscle retracted
part of lamina removed
Decompression without fusion (microdiscectomy)
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
What muscle is generally problematic after being resected due to back surgeries
multifidus
What are the general precautions for a laminectomy
no BLTs
Rotation increases ________ in the lumbar spine, so be careful with these exercises with post-op patients
compression
think: Lumbar trunk rotations, rotational stretches
When a patient gets a microdiscectomy do they have their lamina removed?
no, just a laminotomy
What kind of precautions do lumbar fusion patients have
no BLTs
no active ROM for 12 weeks
more aggressive precautions for fusion than for laminectomy
What happens in a posterior lumbar interbody fusion (PLIF)
Bilateral Muscle strip dissection (Multifidi)
Laminotomy
Dura is retracted
Spacer is inserted between endplates
How does the transforaminal lumbar interbody fusion (TLIF) compare with the PLIF.
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
What are the benefits to the Anterior lumbar interbody fusion (ALIF)
allows better access to entire ventral surface of disc, allows for comprehensive discectomy and direct implant insertion
What is adjecent segment degeneration
vs
Adjacent segment disease
High incidence, radiographic changes of adjacent segments after a surgery REGARDLESS OF SYMPTOMS
Lesser incidence, “disease” is only when adjacent segment causes symptoms
After surgery, altered biomechanics cause changes in the center of rotation
how does this affect the forces through the disc
increased forces and compression on IVD, up to 45% more
What is a decompression with motion preservation (disc replacement)
for single level of disc dysfunction (can be multiple levels)
not intended to stabilize spinal column
When are disc replacement surgeries contraindicated
Hypertrophic facet joints
translational deformities (spondylolithesis)
Contraindicated in segmental autofusion (ankylosing)
Caution in those with poor bone quality
what are 5 considerations for post-surgical managment
- disc hydration
- change position every 15-30 mins
- avoid stretching/rotation of lumbar
- avoid lying prone/flat
- think about healing times
all motions of the sacrum are very __________
small
what SI joint ligament provides the most stability
interosseus ligament
Sacral nutation means what?
flexion of sacrum
What sacrum motion occurs during standing/ landing
Sacral nutation
What motion happens at the sacrum with lordosis positions or with spinal extension which increases lumbar lordosis
sacral nutation
What happens at the sacrum when both innominates rotate posteriorly
sacral nutation
What motion happens with anterior rotation of both innominates
Sacral counternutation
what sacral motion occurs with spinal flexion ( decreased lumbar lordosis)
Sacral counternutation
When does counternutation become an issue in the spine?
when the lumbar spine flexes but the sacrum doesnt move
Inflare of the innominate happens with ___________
outflare of the innominate happens with ___________
hip internal rotation
external rotation
Innominate anterior rotation happens with hip ____________
Innominate posterior rotation happens with hip _______________
extension
Flexion
What kind of innominate rotation will happen in SLS
Posterior rotation of innominae
