Lecture 7: Surgical Interventions for Neck Pain

Question 1

What are some pharmacotherapy agents for neck pain?

Answer 1

1. analgesics/NSAIDS
2. short term opioids
3. oral steroids
4. muscle relaxants
5. epidural injections

Question 2

What is the gold standard diagnostic tool for neck pain?

Answer 2

MRI- most sensitive for detecting soft tissue abnormalities (Herniated disc)

Question 3

What is the most commonly used neck injection?

Answer 3

Methylprenisolone

Question 4

What are the two types of Methylprenisolone?

Answer 4

1. transforaminal- more target specific. more potential complications
2. intralaminar

Question 5

What are indications for neck surgery?

Answer 5

no improvement with conservative tx 6-12 weeks, neuron compression and progressive motor deficit, instability, deformity

Question 6

What are most popular forms of surgical procedures for cervical spine?

Answer 6

1. Anterior approach
2. Posterior decompression
3. minimally invasive

Question 7

What are two kinds of anterior approaches for surgery?

Answer 7

1. cervical discectomy with or without fusion (ACDF)

2. Disc arthroplasty/ artificial disc (ACD)

Question 8

What are the three types of posterior decompression surgeries?

Answer 8

1. foraminotomy
2. laminaplasty
3. laminectomy

Question 9

What is a laminectomy?

Answer 9

removal of the vertebral lamina to decompress the spinal cord (with or without fusion)

Question 10

What is a laminoplasty?

Answer 10

lamina is moved to expand space for spinal cord

Question 11

What is a foraminotomy?

Answer 11

IV foramen canal is expanded only portions of disc touching cord are removed

Question 12

What are the indications for an anterior discectomy?

Answer 12

removal of osteophytes and disc indicated:

1. actue myopathy and myloradiculopathy
2. PND
3. failed conservative
4. significant motor deficits
5. severe pain with no relief

Question 13

What type of disc replacement can be used in a anterior discectomy?

Answer 13

allograft, autograft or synthetic

Question 14

What is the rehab focus post ACDF?

Answer 14

walking program, DNF strength, ice to neck 10 min 3x/day,

Question 15

What is rehab focus in hospital after surgery?

Answer 15

log rolling/posture, cervical collar, temporary hoarseness, difficulty swallowing, dizziness

Question 16

What is the rehab focus post ACDF week 1-2?

Answer 16

progress walking and endurance

Gentle PAIN FREE AROM, no lifting over 10 pounds

Question 17

What is the rehab focus post ACDF week 2-4?

Answer 17

AROM right and left, aerobic exercise

DNF isometrics

can lift 10-30 pounds

Question 18

What is the rehab focus post ACDF 3-6 months?

Answer 18

higher level activities, no overhead lifting, multi plane dynamic functional exercises

Question 19

How long does it typically take a spinal fusion to heal?

Answer 19

3 months its solid may not fully heal up to a year

Question 20

What is a common complication with spinal fusions?

Answer 20

associated with adjacent segment disease, increased were and tear to segments around fusion

transitional syndrome

Question 21

What four types of artificial discs were approved in USA?

Answer 21

Prestige, Prodisc and Bryan disc, Mobi-C

used for spondylosis levels c3-7

these allow for motion at segment of repair

Question 22

What are indications for cervical arthroplasty?

Answer 22

skeletally mature, intractable radic. with or without associated neck pain and same as fusion

Question 23

What is rehab post disc arthroplasty?

Answer 23

PT 2 weeks post op and back to ADL’s in 4 weeks

Question 24

Which outcomes are better for c spine cervical procedures ACDF or arthroplasty?

Answer 24

Arthroplasty, better clinical outcomes, decreases transitional syndrome