spinal surgeries Flashcards
types of decompression surgery (4)
micro/discectomy, laminotomy/ectomy (lumbar & cervical)
types of fusion surgeries
PLIF, ALIF TLIF XLIF and PCIF/ACIF (LIF = lumbar interbody fusion, CIF = cervical)
Dx that call for fusion surgery?
spondylolisthesis & severe spine OA
replacement/refortifying surgery is indicated for what diagnoses (2)? and what are the 2 types of surgery?
vertebral compression fx & DDD
kyphoplasty OR total disc replacement
kyphoplasty v vertebroplasty surgery:
kypho = balloon tamp used, clinical outcomes recommend KP (95% success)
what is the GOAL of a micro/discectomy?
to REMOVE portion of disc that is ID’d as a pain generator (HNP)
hospital LoS for micro v discectomy:
BOTH crazy short; micro OP , discectomy overnight
recovery time (not in hospital typically) for micro/discectomy =
2 wks - 1 mos
gen spinal precautions
how long does it take for a laminectomy w fusinon to become stable?
no exact time line - pedicle screws in place in place of lamina
IF a pt s/p laminectomy (with or w/o fusion) presents with HA, nausea and/or vomiting, what is a possible cause?
dural tear and CSF leakage
what does a PLIF (generally) do?
it’s a FUSION, IVD completely removed and replaced with allograft OR metal cages to REESTABLISH BONE HEIGHT
What fusion sx has the LEAST amt of OR time/blood loss/LoS & fastest return to activity?
XLIF
What segments are inaccessible via XLIF?
L4/L5 & L5/S1
what 2 fusion sx have decr risk of dural tears and multifidus atrophy?
ALIF/ACIF & XLIF
what’s the alt to spinal fusion is you have IVD degen
total disc replacement (used if disc itself ID’d as primary contributor of pain)
what is the general bone maturation/tissue healing time frame for the spine?
8-10 weeks
for a decompression/fusion sx at 1 level, should expect to take … to heal
> 6 mos
WHY SHOULD YOU PROMOTE EARLY HEALTHY ACTIVITY
incr blood flow so you decr healing time/LoS
what position puts more force on L3 disc - standing at ease or sitting with no back support? what about with lumbar support?
sitting with no back support (157 lbs v 112 lbs)
sitting w lumbar support - 90lbs
what ms are weak in Janda’s lower crossed syndome s/p lumbar spine sx?
abs, glut max (tight ES & iliopsoas)
what positions should pts avoid s/p lumbar sx?
sitting > 20-30 min, no prone
some ex of core/postural strengthening exercises used in phase II s/p lumbar sx
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)
incr the flexibility of what 2 ms inherently makes lumbar spine more flexible?
gastroc & hamstring
when may a pt return to work s/p lumbar sx?
about 6 wks - 3 mos minimally invasive sx;
7-10 mos more invasive sx
when can a pt begin lifting again ?
3.5 - 5.5 mos s/p MINIMALLY INVASIVE sx
neck flexor endurance test s/p C-spine sx – what is a NORMAL hold?
x39” (pts w neck pain )
