Rehab after spinal surgery: cervical spine Flashcards
Where does half of rotation come from in cervical spine?
between C1 and C2
What imaging is used to look at C spine?
Radiographs: flexion and extension laterals, rarely oblique or odontoid
MRI: soft tissue definition, non invasive, not as good as figuring out bone pathology
What are surgical indications?
Fracture: major trauma, minor trauma in osteopenia pts
Myelopathy: progressive
Neoplasm
When does a neoplasm become suspicious
age >50
no relief with bed rest
unexplained weight loss
previous cancer history
What are signs of myelopathy?
sensory disturbances in hand, intrinsic muscle wasting of hand, unsteadiness during walking, hyperreflexia
What are the types of cervical spine surgeries?
decompression: laminectomy, discectomy
fusion
What are the approaches of cervical spine surgeries?
anterior: problems swallowing or voice changes
Posterior: more pain secondary to musculature
What are advantages of posterior approach for surgery?
advantages: superior for lateral herniations, safer in patients with bone spurs involving spinal column, allows patients to avoid fusion
What are disadvantages of posterior approach for surgery?
opting against fusion (continued disc collapse and pressure)
Disc may re herniate
More technically difficult
What are symptoms of nerve root impingement?
Pain, weakness, numbness in UE
What is cause of cervical radiculopathy?
disc herniation, bone spurring, or comination
What is mechanism of injury for cervical radiculopathy?
acute injury: forced hyper extension, rotation or combination of both
Spurlings test: if “-“ rule out
What is initial treatment for radiculopathy?
non operative Rest/NSAIDS/oral steroids Traction Nerve root injections 2/3 will improve w/o surgery within 3 months
When is surgery recommended for radiculopathy?
failed conservative management of at least 2-3 months
Progression of neurologic dysfunction, especially weakness
Persistent numbness, especially dominant hand involved
What are surgery options for radiculopathy>?
discectomy
fusion
fusion and discectomy
What is cervical stenosis?
involves narrowing of spinal canal, causes compression of spinal cord or nerve roots
What is cause of stenosis? what might it be related with?
Congenital or acquired
May be related to acute trauma with fracture or disc herniation
What do they do for surgery with stenosis?
laminectomy
What are causes of cervical myelopathy and symptoms?
Cause: spinal cord compression
Symptoms: UE/LE extremity weakness, bowel bladder dysfunction, gait disturbance
What is treatment for cervical myelopathy?
One of few times along with tumor, infection, and trauma, where surgery is indicated
Treatment will often include removal of vertebral body in addition to discs
What is ideal prosthesis (disc replacement) patient ?
Normal sagittal alignment Compression at disc level only No posterior compression No axial neck pain Primary operation, single level, unilateral radiculopathy Non smoker Negative spurlings manuever
What are problems with disc replacements?
Peri-prosthetic ossification
Prosthesis migration anteriorly/posteriorly
What are general rules for acute phase rehab after surgery?
Brace/collar for fusion patients No ROM Keep HOB up Sleep in recliner Look at UE positioning No lifting >5-10 pounds
What should you work on during acute PT after surgery?
bed mobility
ambulation
stairs: brace may block vision
What are key principles for outpatient rehab after surgery?
Precision of movement vs. total ROM
Posture in daily activities
Alignment of shoulder girdle
What are common muscle impairments that may lead to these cervical problems/surgery?
Intrinsic neck muscles become weak or long: compromise fine control, translation versus sagittal rotation
Extrinsic neck muscles become dominant: adds to compressive, rotational, shear forces
What are effects of slumping on posture?
increase thoracic curve
Increase cervical lordosis
Length changes: long anterior flexors, short/stiff post ext
What are rehab strategies of shoulder girdle?
Alignment of shoulder girdle Elevation vs depression: T2-T7 Scapular abduction: 3-4 inches Internal rotation Anterior tilt
How do shoulder muscles affect the spine?
Muscles affect alignment and stress on spine
What is take home message for cervical spine?
alignment of shoulder girdle is key to cervical pain
Alignment of thorax affects alignment of cervical spine
