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Surgical > Med bridge base and spinal > Flashcards

Med bridge base and spinal Flashcards

1
Q

What part of the healing process is consistent between tissues and patients?

A

Relative percentage of total healing time in each phase of healing
- 10% - acute
- 40% - repair
- 70% - remodeling
A longer acute phase means a longer repair phase and remodeling phase

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2
Q

What is unique about the epithelial healing process

A

the coagulation phase - closing of the vessels is the first thing that needs to happen

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3
Q

What consideration must be made with sheath tendons

A

More dependent on diffusion and has area of vascularity

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4
Q

Bone healing has what to unique steps to its healing process

A

Soft callus phase - hematoma and clot transition to soft callus at 1-6 weeks, firborcartilage tissue and vascularization
hard callus has - transition to woven bone at 4-6 weeks
remodeling woven bones change to lamellar bone

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5
Q

What is unique to healing process of nerves

A
  • Wallerian degernation phase - immediate to 3 days - axon distal to the injury is removed during cellular stage and muscle activity is lost
  • Axonal degerneation phase - day 4 to 1mm pre day of growth - schwann cells form a scaffold for the new axon to grow down to the end of the nerve
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6
Q

what Seddon’s classificaiton the different types of nerve injuries

A

Seddon

  • class I Neuropraxia - temporary interruption of nerve conduction
  • class II axonotmesis - loss of nerve continuity with preservation of surround connective matrix, wallerian degeneration loss of nerve function peaking 3-4 days, restoration of nerve function 2-3 weeks post injury
  • class III neurotmesis - disruption of the entire nerve structure requiring surgical innervation to repair
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7
Q

What are sunderland’s classification of nerve injury

A
  • class I - same as Seddon class I
  • class II - same as Seddon class II
  • class III - epineuryium and perineurium are intact, endoneuryium requires repair
  • class IV - only the epineurium is intact
  • class V - complete transection
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8
Q

What MSK complication is associated with the antibiotic fluoroquinolone (cipro)

A

tedonopathy and tendon ruptures for up to 6 months post medication use

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9
Q

What are the normal levels for RBC and hemoglobin

A
  • RBC’s men 4.32-5.72 trillion, women 3.9 to 5.0 trillion

- hemoglobin ment 13.5-17.5 grams per deciliter, women 12.0-15.5 grams deciliter

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10
Q

what is hematocrit and normal values

A
  • test measures of the proportion of red blood cells in your blood
  • men 39-51, women 34-46
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11
Q

What is the value of the creatine kinase assay

A
  • measure of the breakdown of creatine reach tissue (muscle, cardiac or skeletal)
  • normal values men 171 and women 145
  • greater than 2.5-3% heart damage
  • less than 2.5-3% muscle damage
  • significant muscle breakdown causes the number to sky rocket (rhabdo 50K-200K range)
  • neuropathic weakness will have slight increases 500-3500 range)
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12
Q

What are the normal levels for WBC and platelets

A
  • WBC’s 3.5 to 12.5

- 140-400 K/uL

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13
Q

What are normal blood gas tests

A

pH 7.35-7.45
PaCo2 35-45 mmHg
bicarbonate 22-26 mmol/L

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14
Q

What pathologies would require a blood gas test (bag)

A
  • heart failure
  • kidney failure
  • sleep disorder
  • uncontrolled diabetes
  • severe infections
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15
Q

what is a blood uria estrogen test (BUN) ordered for

A
  • 10-20 mg/dL
  • low with rhabdomyolysis, low protein diet, over hydration
  • high with dehydration, kidney disease
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16
Q

How does immobilization impact muscles

A
  • slow twitch (type I) are more affected
  • well trained muscles less effected by immobilization
  • single joint muscle more affected
  • the shortened muscle with decrease while the length muscle with lengthen
  • GAG loss on MTJ
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17
Q

What is arthofibrosis

A

loss of gliding between collagen fibers and stiffening of the tissue due to loss of GAG and pH change

18
Q

Impact of immobilization on meniscus

A
  • loss GAG and water causes reduction in meniscus full size

- delayed healing due to loss vascularization

19
Q

what is the ACDF procedure

A

anterior approached to cervical disc fusion

  • complete disc removal and bone graph placement
  • small plate is place to hold the joint still
20
Q

what structure are taken down with ACDF

A
  • muscle SCM, platysmas, middle and anterior scalene, longus coli pulled off pain
  • ligaments ALL, PLL and joint capsules
21
Q

Describe inflammatory healing after ACDF

A
  • 0-2 weeks - cellular and blood loss prevention, pain and fatigue guide to rehab, collor 100%, avoid overhead lifting, avoid sleeping on your stomach
22
Q

describe reparative phase after ACDF

A

1-3 weeks - bone healing soft callus to hard callus, promote nerve mobility
- rehab unlikely during this stage, pain and fatigue guide to activity

23
Q

describe bone remodeling phase

A
  • consolidation phase 4-9 weeks bone mineralization of callus (usually by day 64)
  • maturation phase 19-52 weeks bone fully converted to lamellar bone and is able to start rehab at this point, tissues need to be remodeled
  • x-ray will confirm healing
24
Q

what are the common complications associated with ACDF

A
  • dysphagia
  • hematoma
  • laryngeal nerve palsy
  • esophageal perforation
25
Q

What demographic variable have the greatest chance of ACDF success

A
  • non smoking males, with low pain, better ROM and low NDI scores
  • surgery within 6 months of injury
26
Q

Indications for microdiscetomy

A 
relative
- disc herniation
- failed conservative treatment
- recurrent radicular symptoms
- neuro deficits
absolute
- progressive neuro deficits
- cauda equina syndrome
27
Q

describe the microdiscetomy procedure

A
  • soft tissues retracted
  • access hole created the lamina and/or ligamentum flavuum
  • nerves are retracted and the offending portion of the disc is removed
28
Q

what is the rehab objective of the inflammatory phase of microdiscectomy

A

weeks 1-3

  • promote healing
  • control pain
  • promote dural mobility
  • avoid prolong flexed position in sitting and sleeping
  • no driving for 2 weeks
  • avoid slump testing, hip strength testing and hip hing lifting
29
Q

describe the reparative phase post microdisctomy

A
  • starts week 4-6
  • cochrane review found high intensity exercise better than low intensity
  • avoid loaded lumbar flexion because healing is not fully complete
30
Q

How long should you avoid running after microdiscectomy

A

12 weeks post op

31
Q

what the indications for progressing to the remodeling phase of rehab following microdiscetomy

A
  • pain control is performed with changing position or light stretching
  • performing all ADL’s
  • can start end range motion assessment
32
Q

what complications are associated with microdiscectomy

A

most common

  • reoperation
  • dural injury
  • recurrent disc complication
  • nerve root damage
  • wound complications
  • new or worsening neuro deficits
  • hematoma
33
Q

What is the prognosis for microdiscectomy

A
  • delay longer than 6 months is associated with worse outcomes
  • success rate up to 90-95% in eliminating radicular symptoms and back pain
  • scores measuring quality of life, depression, disability and pain are know to improve
34
Q

Describe the posterior lumbar fusion procedure

A
  • lamina is removed
  • disc is debrided leaving the out edge of the annulus to hold the bone graph
  • pedical screws are inserted and covered with bone graph
35
Q

how long is the inflammatory phase of fusion

A

up to 6 weeks

- restricted driving and flexion based moments

36
Q

what is the time frame for the reparative phase of fusion

A

6-10 weeks

- avoid loading lumbar spine during this phase and lifting greater than about 10 pounds

37
Q

what are some associated complications with spinal fusion

A
  • intraoperative neurologic injury
  • implant migration
  • dural tears
  • infection
  • heterotophic ossification
  • osteolysis - loss of bone tissue
  • chronic pain
  • adjacent segmental instability
38
Q

what is the prognosis for fusion

A
  • high patient satisfaction and outcome scores
  • decreased pain
  • increased ODI scores
  • post surgical motor loss was the greatest predictor of negative patient outcomes
39
Q

Describe the findings of the 2009 cochrane review of rehab after lumbar disc surgery

A
  • examined exercising starting 4-6 weeks post op
  • low evidence for short term gains exercise being more effective than no exercise
  • moderate evidence for exercise improving functional compared to exercise
  • low evidence for high intensity exercise over low intensity exercise
  • moderate evidence for high intensity providing better functional outcomes
  • low evidence for HEP works as well has formal rehab
  • no evidence for increased reoccurrence of back pain with exercise program after the first surgery
40
Q

what did the Chien 2016 study on ACDF 1 versus 2 level find regarding cervical kinematics

A
  • 2 level fusion had significant impact on ROM and upper segmental compensatory changes (lower did not appear affected)

Surgical (3 decks)

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