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Semester 3 PM Exam 2 > Spinal Surgeries > Flashcards

Spinal Surgeries Flashcards

1
Q

Surgical Intervention of the Cervical Spine reserved for

A

patients with persistent radicular pain who do not respond to conservative measures

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2
Q

Surgical intervention of the cervical spine also for those with

A

Significant extremity or myotomal weakness
Progressive neuro deficits
Severe unremitting pain
Pain the persists beyond a conservative intervention period of 8-12 weeks

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3
Q

Common surgical procedures for cervical disc injuries

A

Ant cervical discectomy and fusion
Ant corpectomy and fusion
Laminectomy and laminotomy-facetectomy
Laminectomy or laminoplasty (with or without fusion)

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4
Q

Laminoplasty

A

One side of the lamina partially scored, the other side cut through, open like a hinge, then add bone graft on opp side to make canal larger

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5
Q

Laminotomy

A

Removes part of the lamina

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6
Q

Anterior cervical discectomy and fusion purpose

A

to remove disc herniations

to relieve spinal cord or nerve root pressure

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7
Q

Ant cervical discectomy and fusion used for what pathologies

A

Lateral and central herniations are removed this way

95% chance of good to excellent relief from radiating arm pain - numbness usually improves too

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8
Q

Ant cervical discectomy and fusion - outcome

A

resume full, unrestricted activity activity 3-6 months

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9
Q

Ant cervical discectomy and fusion - complications Rare

A 
Sore throat
Hoarseness
Difficulty swallowing
Failure of bony fusion 
Pseudoarthrosis (non-union)
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10
Q

Ant cervical discectomy and fusion - advantages to fusion

A

Provides stability to the motion segment

Immobilize painful degenerative disc and facets

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11
Q

Ant cervical discectomy and fusion - disadvantages to fusion

A

Progression of degenerative changes at other levels

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12
Q

Anterior Corpectomy and Fusion is what

A

Removal of the vertebral body as well as the disc spaces at either end, to completely decompress the cervical canal

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13
Q

Ant corpectomy and fusion is performed when

A

cervical disease encompasses more than just the disc space
multi level cervical stenosis
or spinal cord compression caused by growth of bone spur

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14
Q

Ant corpectomy and fusion - post op

A

Rigid cervical orthosis often used

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15
Q

Laminectomy often used to treat

A

Spinal stenosis
Resect lamina on one or both sides
Inc axial space available for spinal cord
Usually done when more than one level involved

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16
Q

Goals of laminectomy

A

Progression of spinal cord damage should stop

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17
Q

Outcome with laminectomy

A

Functional return for walking and use of hands - if the nerve damage was not too severe and has not become permanent

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18
Q

Complications with laminectomy

A

Instability
Post-laminectomy kyphosis (requires surgical revision)
Myofascial pain
Occipital headaches

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19
Q

Laminoplasty indicated for

A

multi-level spondylotic myelopathy
Superior functional recovery compared to laminectomy for spondylotic myelopathy (people do better with this for cord compression as opposed to a laminectomy)

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20
Q

Complication with laminoplasty

A

Nerve root injury can occur in 11% cases

Potentially caused by traction on enrve roots with post migration of the cord

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21
Q

Post-surgical PT

A

no set guidelines
Important to have communication with the surgeon - protocols vary based on surgery, surgeon, patient - need to consider bone healing time if fusion

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22
Q

Post-operative brace

A

Used following some surgeries
Brace first few weeks or months
Padded, plastic neck brace or cervicothoracic brace
Reduces the pain and stress on the neck
Improves bone healing by maintaining the neck in right position

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23
Q

Goals: Initial period following surgery

A 
Reduce pain and inflammation 
Prevent postsurgical complications
Protect the surgical site 
Prevent recurrent herniations
Maintain dural mobility
Improve function
Minimize detrimental effects of immobilization
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24
Q

Early return to function - instruct in

A

Bed mobility
Gait
Transfers
Wound Care

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25
Q

Early return to function - 1 week:

A

Patients are usually permitted to shower

26
Q

Early return to function - 7 to 10 days

A

Safe return to sedentary occupational duties/avoid prolonged positions

27
Q

Early return to function - Encourage

A

short walks several times a day

28
Q

Out patient PT - begins

A

week 2 or 3 if appropriate

depending on procedure done and individual patient

29
Q

Out patient PT - Examination

A

Thorough history
Inspect wound site
Postural exam
Neural exam including neurodynamic and strength testing

30
Q

Out patient PT - Intervention

A 
Education posture/body
Mechanics
Gentle ROM
Submax isometrics
Arm and led exercises (avoid heavy lifting 4-6 weeks)
Electrotherapeutic modalities
Physical agents
Scar massage
31
Q

Out patient PT - intervention - week 4 post op

A

progressive strengthening exercises for spinal stabilizers

32
Q

Out patient PT - intervention - cardiovascular conditioning exercises

A

Stationary bicycle; UBE; stair stepper, swimming

Start brief 5-10min, gradually inc to 30-60min

33
Q

Out patient PT - intervention - 6 to 8 weeks

A

jogging permitted if minimal pain

Morning activities are best (disc maximally hydrated)

34
Q

Out patient PT intervention - 12 weeks

A

Higher impact sports like basketball or soccer usually permitted

35
Q

Surgeries for lumbar radiculopathy

A
  1. Diskectomy
    - hemilaminectomy and diskectomy
    - percutaneous diskectomy
    - microdiskectomy
  2. Laminectomy
  3. Decompression
  4. Fusion
36
Q

Aims of lumbar surgery for radiculopathy

A
  1. Relieve pain

2. Restore neural function

37
Q

Diskectomy - Hemilaminectomy and Diskectomy

A

Posterior approach

To treat herniated lumbar IVD

38
Q

Diskectomy - Hemilaminectomy and Diskectomy - Aims

A

Decompress involved nerve root
Minimize scar formation
Avoid latrogenic nerve damage

39
Q

Diskectomy - Percutaneous Diskectomy

A

Minimally invasive
Uses probe for aspiration of the NP material from the IVD
For those w/o stenosis, severe arthritis, hypertrophy

40
Q

Microdiscectomy - what is it

A

Removal of disc materal causing compression or irritation of a nerve root
Ligamentum flavum and part of facet is removed

41
Q

Microdiscectomy - success rate

A

Greater than 90% success rate

Patients are usually able to return to previous activity level/sports

42
Q

Laminectomy

A

removal of the lamina

invovles removal of SP and ligamentum flavum caudal and cranial to the lamina

43
Q

Laminectomy - disadvantage

A

Destabilizing effect on the segment

44
Q

Decompression

A

Laminectomy with partial facetectomy

May include laminoplasty or unilateral laminotomy for canal enlargement

45
Q

Fusion

A

Lack of consensus on indications

  • spinal stenosis
  • Degenerative disc disease with no herniation or stenosis
46
Q

Fusion compared to laminectomy without a fusion

A

Wider surgical exposure/more extensice dissection

Longer operation time

47
Q

Fusion - advantages for recurrent disc herniations

A

Reduce/eliminate segmental motion
Reduce stress on degenerated disk space
Reduce incidence of additional herniation at the affected disc space

48
Q

Fusion - Bone grafts

A

Autologous or allograft or bone matrix product

49
Q

Fusion - Interbody cages

A

Anterior lumbar interbody fusion (ALIF)
Posterior lumbar interbody fusion (PLIF)
Plates
Pedicle Screws

50
Q

Post-surgical PT - lumbar

A

No set guidelines again

Communicate with surgeon

51
Q

Goals - initial period following surgery - lumbar

A 
Reduce pain and inflammation
Prevent postsurgical complications
Protect the surgical site
Prevent recurrent herniation
Maintain dural mobility
Improve function
Minimize detrimental effects of immobilization
52
Q

Early return to function - instruct in (lumbar)

A 
Bed mobility
Gait
Transfers
Wound care
Body mechanics
53
Q

Early return to function - lumbar - 1 week

A

Patients are usually permitted to shower

54
Q

Early return to function - instruct in (lumbar) - 7 to 10 days

A

Safe return to sedentary occupational duties/avoid prolonged positions

55
Q

Early return to function (lumbar) - driving? encourage…

A

No driving for 2 weeks

Encourage short walks several times per day

56
Q

Out patient PT - lumbar - begin

A

week 2 or 3 if appropriate

Depending on procedure done and individual patient

57
Q

Out patient PT - lumbar - Examination

A

Thorough history
Inspect wound site
Postural exam
Neural exam including neurodynamic and strength testing

58
Q

Out patient PT - lumbar - intervention

A 
Education posture/body mechanics
Gentle ROM
Submaximal isometrics
Arm and leg exercises (4 to 6 weeks)
Electrotherapeutic modalities
Physical agents
Scar massage
59
Q

Out patient PT - lumbar intervention - week 4 post op

A

progressive strengthening exercises for spinal stabilizers

60
Q

Out patient PT - lumbar intervention - Cardiovascular conditioning exercises

A

Stationary bike, UBE, stair stepper, swimming, start brief 5-10 min, gradually inc to 30-60 min

61
Q

Out patient PT - lumbar intervention - 12 weeks

A

Higher impact sports like basketball or soccer usually permitted; work hardening

62
Q

Complications following surgery - lumbar

A 
Not specific to spinal surgeries
Post surgical infection
Poor wound healing
Scars and adhesions
Venous thromboembolism
Pulmonary embolus
Weakness or muscle atrophy
Psychosocial problems/yellow flags/fear avoidance

Semester 3 PM Exam 2 (4 decks)

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