spinal surgeries

Question 1

types of decompression surgery (4)

Answer 1

micro/discectomy, laminotomy/ectomy (lumbar & cervical)

Question 2

types of fusion surgeries

Answer 2

PLIF, ALIF TLIF XLIF and PCIF/ACIF (LIF = lumbar interbody fusion, CIF = cervical)

Question 3

Dx that call for fusion surgery?

Answer 3

spondylolisthesis & severe spine OA

Question 4

replacement/refortifying surgery is indicated for what diagnoses (2)? and what are the 2 types of surgery?

Answer 4

vertebral compression fx & DDD

kyphoplasty OR total disc replacement

Question 5

kyphoplasty v vertebroplasty surgery:

Answer 5

kypho = balloon tamp used, clinical outcomes recommend KP (95% success)

Question 6

what is the GOAL of a micro/discectomy?

Answer 6

to REMOVE portion of disc that is ID’d as a pain generator (HNP)

Question 7

hospital LoS for micro v discectomy:

Answer 7

BOTH crazy short; micro OP , discectomy overnight

Question 8

recovery time (not in hospital typically) for micro/discectomy =

Answer 8

2 wks - 1 mos

gen spinal precautions

Question 9

how long does it take for a laminectomy w fusinon to become stable?

Answer 9

no exact time line - pedicle screws in place in place of lamina

Question 10

IF a pt s/p laminectomy (with or w/o fusion) presents with HA, nausea and/or vomiting, what is a possible cause?

Answer 10

dural tear and CSF leakage

Question 11

what does a PLIF (generally) do?

Answer 11

it’s a FUSION, IVD completely removed and replaced with allograft OR metal cages to REESTABLISH BONE HEIGHT

Question 12

What fusion sx has the LEAST amt of OR time/blood loss/LoS & fastest return to activity?

Answer 12

XLIF

Question 13

What segments are inaccessible via XLIF?

Answer 13

L4/L5 & L5/S1

Question 14

what 2 fusion sx have decr risk of dural tears and multifidus atrophy?

Answer 14

ALIF/ACIF & XLIF

Question 15

what’s the alt to spinal fusion is you have IVD degen

Answer 15

total disc replacement (used if disc itself ID’d as primary contributor of pain)

Question 16

what is the general bone maturation/tissue healing time frame for the spine?

Answer 16

8-10 weeks

Question 17

for a decompression/fusion sx at 1 level, should expect to take … to heal

Answer 17

> 6 mos

Question 18

WHY SHOULD YOU PROMOTE EARLY HEALTHY ACTIVITY

Answer 18

incr blood flow so you decr healing time/LoS

Question 19

what position puts more force on L3 disc - standing at ease or sitting with no back support? what about with lumbar support?

Answer 19

sitting with no back support (157 lbs v 112 lbs)

sitting w lumbar support - 90lbs

Question 20

what ms are weak in Janda’s lower crossed syndome s/p lumbar spine sx?

Answer 20

abs, glut max (tight ES & iliopsoas)

Question 21

what positions should pts avoid s/p lumbar sx?

Answer 21

sitting > 20-30 min, no prone

Question 22

some ex of core/postural strengthening exercises used in phase II s/p lumbar sx

Answer 22

pelvic tilting
abdominal setting/breathing
abdominal setting w ext cue (ball b/t knees)
ab setting w alt knee fall out (dissoc pelvis from LEs)

Question 23

incr the flexibility of what 2 ms inherently makes lumbar spine more flexible?

Answer 23

gastroc & hamstring

Question 24

when may a pt return to work s/p lumbar sx?

Answer 24

about 6 wks - 3 mos minimally invasive sx;

7-10 mos more invasive sx

Question 25

when can a pt begin lifting again ?

Answer 25

3.5 - 5.5 mos s/p MINIMALLY INVASIVE sx

Question 26

neck flexor endurance test s/p C-spine sx – what is a NORMAL hold?

Answer 26

x39” (pts w neck pain )