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PTRS 845 > Rehab after spinal surgery: cervical spine > Flashcards

Rehab after spinal surgery: cervical spine Flashcards

1
Q

Where does half of rotation come from in cervical spine?

A

between C1 and C2

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2
Q

What imaging is used to look at C spine?

A

Radiographs: flexion and extension laterals, rarely oblique or odontoid
MRI: soft tissue definition, non invasive, not as good as figuring out bone pathology

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3
Q

What are surgical indications?

A

Fracture: major trauma, minor trauma in osteopenia pts
Myelopathy: progressive
Neoplasm

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4
Q

When does a neoplasm become suspicious

A

age >50
no relief with bed rest
unexplained weight loss
previous cancer history

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5
Q

What are signs of myelopathy?

A

sensory disturbances in hand, intrinsic muscle wasting of hand, unsteadiness during walking, hyperreflexia

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6
Q

What are the types of cervical spine surgeries?

A

decompression: laminectomy, discectomy

fusion

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7
Q

What are the approaches of cervical spine surgeries?

A

anterior: problems swallowing or voice changes
Posterior: more pain secondary to musculature

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8
Q

What are advantages of posterior approach for surgery?

A

advantages: superior for lateral herniations, safer in patients with bone spurs involving spinal column, allows patients to avoid fusion

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9
Q

What are disadvantages of posterior approach for surgery?

A

opting against fusion (continued disc collapse and pressure)
Disc may re herniate
More technically difficult

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10
Q

What are symptoms of nerve root impingement?

A

Pain, weakness, numbness in UE

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11
Q

What is cause of cervical radiculopathy?

A

disc herniation, bone spurring, or comination

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12
Q

What is mechanism of injury for cervical radiculopathy?

A

acute injury: forced hyper extension, rotation or combination of both
Spurlings test: if “-“ rule out

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13
Q

What is initial treatment for radiculopathy?

A 
non operative
Rest/NSAIDS/oral steroids
Traction
Nerve root injections
2/3 will improve w/o surgery within 3 months
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14
Q

When is surgery recommended for radiculopathy?

A

failed conservative management of at least 2-3 months
Progression of neurologic dysfunction, especially weakness
Persistent numbness, especially dominant hand involved

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15
Q

What are surgery options for radiculopathy>?

A

discectomy
fusion
fusion and discectomy

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16
Q

What is cervical stenosis?

A

involves narrowing of spinal canal, causes compression of spinal cord or nerve roots

17
Q

What is cause of stenosis? what might it be related with?

A

Congenital or acquired

May be related to acute trauma with fracture or disc herniation

18
Q

What do they do for surgery with stenosis?

A

laminectomy

19
Q

What are causes of cervical myelopathy and symptoms?

A

Cause: spinal cord compression
Symptoms: UE/LE extremity weakness, bowel bladder dysfunction, gait disturbance

20
Q

What is treatment for cervical myelopathy?

A

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

21
Q

What is ideal prosthesis (disc replacement) patient ?

A 
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
22
Q

What are problems with disc replacements?

A

Peri-prosthetic ossification

Prosthesis migration anteriorly/posteriorly

23
Q

What are general rules for acute phase rehab after surgery?

A 
Brace/collar for fusion patients
No ROM
Keep HOB up
Sleep in recliner
Look at UE positioning
No lifting >5-10 pounds
24
Q

What should you work on during acute PT after surgery?

A

bed mobility
ambulation
stairs: brace may block vision

25
Q

What are key principles for outpatient rehab after surgery?

A

Precision of movement vs. total ROM
Posture in daily activities
Alignment of shoulder girdle

26
Q

What are common muscle impairments that may lead to these cervical problems/surgery?

A

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

27
Q

What are effects of slumping on posture?

A

increase thoracic curve
Increase cervical lordosis
Length changes: long anterior flexors, short/stiff post ext

28
Q

What are rehab strategies of shoulder girdle?

A 
Alignment of shoulder girdle
Elevation vs depression: T2-T7
Scapular abduction: 3-4 inches
Internal rotation
Anterior tilt
29
Q

How do shoulder muscles affect the spine?

A

Muscles affect alignment and stress on spine

30
Q

What is take home message for cervical spine?

A

alignment of shoulder girdle is key to cervical pain

Alignment of thorax affects alignment of cervical spine

PTRS 845 (9 decks)

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