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PTRS 845 > Rehab after lumbar spinal surgery > Flashcards

Rehab after lumbar spinal surgery Flashcards

1
Q

What are indications for imaging of the spine?

A 
Back pain in kids 55 with severe pain
History of violent trauma
Night pain
History of cancer
Systemic steroids
Drug abuse, HIV
Marked morning stiffness
Persistent severe restriction of motion
Severe pain with motion
Structural deformity
Difficulty with urination
Loss of bowel, bladder, saddle anesthesia
Motor weakness or gait disturbance
Peripheral joint involvement
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2
Q

What imaging techniques are used for the spine?

A

Plain radiographs: younger patients with spondylolisthesis, older patients with possible compression fracture
MRI: best if looking for neural compression, also good for infection

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3
Q

What are common conditions considered for surgery?

A

Herniated Disc
Stenosis
Spondylolisthesis

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4
Q

What are surgical approaches used for lumbar spine surgeries?

A

Decompression

Limit motion- fusion

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5
Q

What is surgeon perspective on treatment of herniated lumbar discs?

A

Most get better with time.
Lumbar epidural may help
PT- less likely to refer (misconceptions: active exercise exacerbates condition, modalities may be beneficial)

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6
Q

Is surgery used for herniated lumbar discs?

A

In properly selected patients surgery is successful (discectomy/microdiscectomy)

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7
Q

What is the perfect surgical candidate for herniated lumbar discs?

A

positive SLR
concordant imaging (extruded disc herniations)
95% success

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8
Q

What is technique for discectomies?

A

discectomy: 3 cm incision, dissect muscles away, laminotomy, disc material removed
Endoscopic microdiscectomy: smaller incision, less tissue dissection, retract SC, remove disc material

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9
Q

What are problems with comparing conservative versus surgical treatments with disc herniations?

A

Variability in inclusion criteria
Form of conservative management: PT, injections, meds
Definition of success
Randomized controlled trials: adherence to assigned groups- 40% crossover

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10
Q

Based on severity of lesion what must be considered for surgery?

A

Disc protrusions: 3x more likely to require revision surgery after initial discectomy
Disruption of annulus: fragment fissure has 1% chance for reherniation/re-op, fragment defect has 27% reherniation/21% reop, no fragment contained

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11
Q

Is there consensus on herniation fixing itself?

A

No concensus
Large uncontained more likely to spontaneously resolve because of exposure to epidural blood supply
Small contained through dehydration

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12
Q

What are complications of herniation surgeries?

A

Long term follow up: pts with discectomy 10 years later 25% had reop
40% reoperated on within 1 year: maybe because of severity of disease process or poor patient selection

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13
Q

Who are surgical candidates for discectomy?

A

Cauda equine
Severe motor deficit: MMT 1-2/5, within 3 months
No low back pain: absence of degenerative condition
Few psychosocial stressors

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14
Q

What are indications for conservative therapy instead of surgery for disc herniations?

A 
Length: minimum 6 months
PT: directional preference
Disc protrusions
Annular disruption
Mild to moderate weakness: 3-4/5
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15
Q

Who get spinal stenosis and what do they complain of?

A 
Most common in older ages (50 and up)
History of activity related leg pain
Negative SLR
Classic neurogenic claudication
Must rule out vascular claudication during exam
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16
Q

What is neurogenic claudication?

A

Leg pain brought on by walking, relieved by sitting (flexion increases spinal canal)
May be improved by walking uphill
treadmill: 3-4 mph, 3-5% incline
Nustep: increase intensity to see if it causes pain

17
Q

What is surgeon perspective for treatment for spinal stenosis?

A

Nothing: brace, pain meds, activity modification
Epidurals: beneficial, better for the elderly
Surgery: 80% success, laminectomy (decompression)

18
Q

What are complication for surgery for spinal stenosis

A

Rare to have condition in isolation: patients have spondylolisthesis or scoliosis on top of stenosis
Need a concomitant arthrodesis
Increases morbidity of operation

19
Q

What is etiology of spondylolisthesis?

A

degenerative, isthmic: fracture, dysplastic: congenital, post-surgical

20
Q

What are symptoms of spondylolisthesis?

A

Occurs in 5% of population

back pain, leg pain, or combination of the two

21
Q

What is surgeons perspective for treating spondylolisthesis?

A

Bracing, pain meds, PT for grades 1 and 2 (stabilization/core training)
Epidurals
Surgery for grade 3 and 4 (requires arthrodesis, +/- decompression)

22
Q

What are approaches for lumbar fusion? success rate?

A

anterior, posterior, 360

Cochrane review: 50% success rate

23
Q

What are surgical complications of fusions?

A

5 year reoperation rate
addition dx: DDD or instability
Direct complications: decreased bone mineral density, segmental instability

24
Q

What are general precautions for spinal fusion?

A

Log roll, spinal orthotics, no hip flexion >90, no twisting/bending/rotation, no forward bending/stooping, no lifting >5-10lbs, no sitting >30 minutes (compression)

25
Q

What are rehab strategies for fusions in inpatient acute setting?

A

primary: walking, bed mobility, transfers

26
Q

What are special considerations for inpatient acute rehab strategies for patients with fusion?

A 
most difficult to transfer supine to/from sit (flop on return)
anterior approach (disruption of bowels, need to mobilize)
27
Q

What are JOSPT guidelines for LBP?

A

primary goals in treating low back pain: reduce frequency of recurrence, prevent progression from acute to chronic
Slow degenerative process, reduce loads on already damaged spine

28
Q

What are rehab strategies for lumbar spine after surgery?

A

Surgery addressed pain therapy should address cause
Motor control and precision of movement
Kinesiopathology: how movement induces pathology

29
Q

What should you address early in rehab for outpatient lumbar spine?

A

Positions of comfort: gives patient sense of control

Functional tasks: address what patient is doing each day

30
Q

What should we do as therapists to address the cause of their back problems?

A

Do they have movement faults (flex, ext, rotation) during functional movements (sit to stand, stairs, walking, forward bending)

31
Q

What would sit to stand look like if they had flex or ext impairment?

A

sit to stand: if flexion was issue they would initiate with trunk bend, extension they’d come up with lumbar extension instead of hips

32
Q

How would someone go up stairs if they had extension problem?

A

use hamstrings more

33
Q

What are rehab strategies in regards to stabilization after surgery?

A

Maintain mild abdominal contraction: abdominal hollowing and bracing, develop muscular endurance

PTRS 845 (9 decks)

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