Lecture 7: Surgical Interventions for Neck Pain Flashcards
What are some pharmacotherapy agents for neck pain?
- analgesics/NSAIDS
- short term opioids
- oral steroids
- muscle relaxants
- epidural injections
What is the gold standard diagnostic tool for neck pain?
MRI- most sensitive for detecting soft tissue abnormalities (Herniated disc)
What is the most commonly used neck injection?
Methylprenisolone
What are the two types of Methylprenisolone?
- transforaminal- more target specific. more potential complications
- intralaminar
What are indications for neck surgery?
no improvement with conservative tx 6-12 weeks, neuron compression and progressive motor deficit, instability, deformity
What are most popular forms of surgical procedures for cervical spine?
- Anterior approach
- Posterior decompression
- minimally invasive
What are two kinds of anterior approaches for surgery?
- cervical discectomy with or without fusion (ACDF)
2. Disc arthroplasty/ artificial disc (ACD)
What are the three types of posterior decompression surgeries?
- foraminotomy
- laminaplasty
- laminectomy
What is a laminectomy?
removal of the vertebral lamina to decompress the spinal cord (with or without fusion)
What is a laminoplasty?
lamina is moved to expand space for spinal cord
What is a foraminotomy?
IV foramen canal is expanded only portions of disc touching cord are removed
What are the indications for an anterior discectomy?
removal of osteophytes and disc indicated:
- actue myopathy and myloradiculopathy
- PND
- failed conservative
- significant motor deficits
- severe pain with no relief
What type of disc replacement can be used in a anterior discectomy?
allograft, autograft or synthetic
What is the rehab focus post ACDF?
walking program, DNF strength, ice to neck 10 min 3x/day,
What is rehab focus in hospital after surgery?
log rolling/posture, cervical collar, temporary hoarseness, difficulty swallowing, dizziness
What is the rehab focus post ACDF week 1-2?
progress walking and endurance
Gentle PAIN FREE AROM, no lifting over 10 pounds
What is the rehab focus post ACDF week 2-4?
AROM right and left, aerobic exercise
DNF isometrics
can lift 10-30 pounds
What is the rehab focus post ACDF 3-6 months?
higher level activities, no overhead lifting, multi plane dynamic functional exercises
How long does it typically take a spinal fusion to heal?
3 months its solid may not fully heal up to a year
What is a common complication with spinal fusions?
associated with adjacent segment disease, increased were and tear to segments around fusion
transitional syndrome
What four types of artificial discs were approved in USA?
Prestige, Prodisc and Bryan disc, Mobi-C
used for spondylosis levels c3-7
these allow for motion at segment of repair
What are indications for cervical arthroplasty?
skeletally mature, intractable radic. with or without associated neck pain and same as fusion
What is rehab post disc arthroplasty?
PT 2 weeks post op and back to ADL’s in 4 weeks
Which outcomes are better for c spine cervical procedures ACDF or arthroplasty?
Arthroplasty, better clinical outcomes, decreases transitional syndrome
