Spine Flashcards
What are the influences of gravity on postural alignment?
Places stress on structures responsible for maintaining the body upright
Due to body’s anterior/posterior sway, muscles are necessary to control sway and maintain equilibrium
Where is the gravity line for the ankle?
Gravity line is anterior to the joint and tends to rotate the tibia forward, stability is provided by plantarflexor muscles
Where is the gravity line for the knee?
Gravity line is anterior to the knee joint (keeps knee in extension)
Where is the gravity line for the hip?
Gravity line varies with body’s sway, when the line passes through the hip joint, there is equilibrium
Where is the gravity line for the trunk?
Gravity line passes through the bodies of the lumbar and cervical vertebrae
Where is the gravity line for the head?
Gravity line falls anterior to the atlanto-occipital joints
Posterior cervical muscles contract to keep the head balanced
What are the common causes of lordotic posture?
sustained faulty posture
pregnancy
obesity
weak abdominal muscles
What are the potential muscle impairments of lordotic posture?
impairment in hip flexor muscles
What are the potential source of symptoms in lordotic posture?
stress to anterior longitudinal ligament, narrowing of posterior disk space, approximation of the articular facets
What are common causes of relaxed/slouched/swayback posture?
- muscles are not used to provide support
- passive structures provide stability
What are potential muscle impairments of relaxed/slouched/swayback posture?
- mobility impairment in the upper abdominal muscles
- impaired muscle performance due to stretched and weak lower abdominal muscles
- extensor muscles of the lower throacic region
- hip flexor muscles
What are the potential source of symptoms of relaxed/slouched/swayback posture?
- stress to iliofemoral ligaments
- anterior longitudinal ligament of the lower lumbar spine
- posterior longitudinal ligament of the upper lumbar and thoracic spine
What are the common causes of flat low-back posture?
- continued slouching or flexing in sitting or standing postures
- too much emphasis on flexion exercises
What are the characteristics of flat low-back posture?
- characterized by a decreased lumboscaral angle
- decreased lumbar lordosis
- hip extension
- posterior tilting of the pelvis
What are the potential muscle impairments of flat low-back posture?
- mobility impairment in trunk flexor muscles an hip extensor muscles
- impaired muscle performance due to stretched ad weak lumbar extensor and possible hip flexor muscles
What are the potential source of symptoms of flat low-back posture?
- lack or normal lordotic curce
- stress to posterior longitudinal ligament
- increased posterior disk space
What is the position of the pelvis in lordosis posture?
-anteriorly tilited
What is the position of the pelvis in kyphosis/lordosis?
-anteriorly tilted
What is the position of the pelvis in sway back posture?
-posteriorly tilted
Common faulty postures:
- round back with forward head
- flat upper back and neck posture
- scoliosis
- structural scoliosis
- non-structural scoliosis
Acute inflammatory stage:
less than 4 weeks
- constant pain
- signs of inflammation
- pain is not completely relieved by position or movement
Acute stage without signs of inflammation:
- symptoms are intermittent
- related to mechanical deformation
- signs of irritability when nerve root or spinal nerve is compressed or placed under tension
Subacute stage
(4 to 12 weeks)
-certain movements and postures provoke symptoms, including some IADLS
Chronic stage
(more than 12 weeks)
-emphasis is placed on returning the patient to high-level activities
Acute Spinal Problems/Protection Phase
Patient education
Symptoms relief or comfort
Kinesthetic awareness of safe postures and effects of movement
Core muscle activation and basic stabilization
Basic functional movements
Subacute Spinal Problems/Controlled Motion Phase
Pain management Kinesthetic training Stretching/mobilization Muscle performance Cardiopulmonary conditioning Postural stress management and relaxation exercises Functional activities
Chronic Spinal Problems/Return to Function Phase
Emphasize spinal control during high intensity and repetitive activities Increased mobility Improved muscle performance Increased cardiopulmonary endurance Patient education
What constitues patient education in chronic spinal problems?
Posture correction
Safe-progression to high-level or high-intensity activities
Self-maintenance and healthy exercise habits
What exercises of skills that all patients with spinal impairments should learn:
Kinesthetic training
Stabilization training
Functional training
Kinesthetic training:
Awareness and control of safe spinal motion
Awareness of neutral spinal position
Awareness of effects of ADLs and extremity motion on the spine
Stabilization training:
Core muscle activation and sustained contraction
Global muscle control of spinal posture with extremity loading
Functional training
Log roll supine to prone, prone to supine
Supine to side-lying to sitting and return
Sit to stand and return
Walking
Patient education:
Patient participates in identifying desired outcomes
Education regarding stages of healing
Limit passive treatment, patient needs to be engaged in the process
Instruction in self-management
Instruction in prevention of future injury or reinjury
Indications for spine surgery:
Relief of pain related symptoms with disc disease
Management of fractures
Management of hypermobile spinal segments
Management of deformities
Removal of tumors
Anterior surgical approach for ACDF:
C3-C7 for cervical approach
thyroid, trachea, esophagus
Anterior retroperitoneal approach:
lumbar spine
Posterior approach
lumbar spine
Indications for surgery for discectomy and microdiscetomy
Upper or lower extremity radiculopathy due to nerve root irritation that have failed conservative measures
Removal of disc fragments and herniated disc material
-compressing the adjacent nerve root
Microdiscectomy:
Procedure purpose is the same as discectomy
Performed through a smaller incision under greater magnification
Laminectomy:
May accompany discectomy
Spinal lamina is removed for greater exposure of a nerve root; ligamentum flavum also removed
Corpectomy:
removal of part of vertebral body
Disadvantage of laminectomy:
exposure of spinal cord
When is fusion indicated?
Pt. presents with axial pain combined with instability, arthritic changes, or uncontrolled peripheral pain
Types of fusion
ACDF
TLIF
Platysma and longus coli muscles are interrupted
Vertebroplasty
Injectable substance (Polymethylmethacrylate) permeates cancellous bone
Stabilization
‘Internal casting’
Kyphoplasty
Balloon insertion
Injection of PMMA
What is a drawback of vertebroplasty?
Lack of height restoration and deformity restoration
What are compression fracture treatment?
kyphoplasty and vertebroplasty
Scoliosis Correction
Installation of hardware to correct spinal deformity
Performed when Cobb angle is > 40 degrees
Complications with C-spine surgeries:
Paralysis
Recurrent laryngeal nerve impairment
Speaking volume diminished
Hoarseness
Complications with all spine surgeries
Paralysis Infection Dural tear with CSF leak Non-union Radiating pain General surgical complications: DVT, pneumonia
What is important to emphasize after surgery?
Early mobility Precautions Bending, twisting, lifting Body Mechanics education Bracing Transfers: Log Rolling Walking program Incision inspection
Incision Inspection:
rubor (redness) Calor (heat) dolor (pain) tumor (swelling) functio laesa (loss of function)
Maximum Protective Phase:
- patient education
- would management & pain control (inspection)
- bed mobility
- bracing
- exercises
- contraindications
Bracing:
Philadelphia collar for ACDF
TLSO or LSO for TLIF
What exercises are avoided in maximum protective phase?
- extension for patient’s having undergone laminectomy
- twisting
- encourage internal bracing of abdomen
- lifting within appropriate limits
Moderate and Minimum Protective Phases:
- scar tissue mobilization
- progressive stretching and joint mobilization
- muscle performance
- gait training
- contraindications
What stretching and joint mobilizations are done in the moderate and protective phases?
Gentle (Grade 1 and 2) joint techniques at adjacent segments to surgical site
Pain modulation
ROM
What muscle performance is done in the moderate and protective phases?
Segmental to global stabilization
Patient goals for activity return
Single plane to multi-planar movements
What gait training is done in the moderate and protective phases?
Postural neutrality
What are the contraindication in the moderate and minimum phases?
Mobilizations on the level(s) of the fusion
Extension exercises for patients having undergone a laminectomy
