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Acute > Spine > Flashcards

Spine Flashcards

1
Q

What are the influences of gravity on postural alignment?

A

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

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2
Q

Where is the gravity line for the ankle?

A

Gravity line is anterior to the joint and tends to rotate the tibia forward, stability is provided by plantarflexor muscles

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3
Q

Where is the gravity line for the knee?

A

Gravity line is anterior to the knee joint (keeps knee in extension)

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4
Q

Where is the gravity line for the hip?

A

Gravity line varies with body’s sway, when the line passes through the hip joint, there is equilibrium

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5
Q

Where is the gravity line for the trunk?

A

Gravity line passes through the bodies of the lumbar and cervical vertebrae

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6
Q

Where is the gravity line for the head?

A

Gravity line falls anterior to the atlanto-occipital joints

Posterior cervical muscles contract to keep the head balanced

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7
Q

What are the common causes of lordotic posture?

A

sustained faulty posture
pregnancy
obesity
weak abdominal muscles

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8
Q

What are the potential muscle impairments of lordotic posture?

A

impairment in hip flexor muscles

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9
Q

What are the potential source of symptoms in lordotic posture?

A

stress to anterior longitudinal ligament, narrowing of posterior disk space, approximation of the articular facets

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10
Q

What are common causes of relaxed/slouched/swayback posture?

A
  • muscles are not used to provide support

- passive structures provide stability

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11
Q

What are potential muscle impairments of relaxed/slouched/swayback posture?

A
  • 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
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12
Q

What are the potential source of symptoms of relaxed/slouched/swayback posture?

A
  • stress to iliofemoral ligaments
  • anterior longitudinal ligament of the lower lumbar spine
  • posterior longitudinal ligament of the upper lumbar and thoracic spine
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13
Q

What are the common causes of flat low-back posture?

A
  • continued slouching or flexing in sitting or standing postures
  • too much emphasis on flexion exercises
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14
Q

What are the characteristics of flat low-back posture?

A
  • characterized by a decreased lumboscaral angle
  • decreased lumbar lordosis
  • hip extension
  • posterior tilting of the pelvis
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15
Q

What are the potential muscle impairments of flat low-back posture?

A
  • 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
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16
Q

What are the potential source of symptoms of flat low-back posture?

A
  • lack or normal lordotic curce
  • stress to posterior longitudinal ligament
  • increased posterior disk space
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17
Q

What is the position of the pelvis in lordosis posture?

A

-anteriorly tilited

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18
Q

What is the position of the pelvis in kyphosis/lordosis?

A

-anteriorly tilted

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19
Q

What is the position of the pelvis in sway back posture?

A

-posteriorly tilted

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20
Q

Common faulty postures:

A
  • round back with forward head
  • flat upper back and neck posture
  • scoliosis
  • structural scoliosis
  • non-structural scoliosis
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21
Q

Acute inflammatory stage:

A

less than 4 weeks

  • constant pain
  • signs of inflammation
  • pain is not completely relieved by position or movement
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22
Q

Acute stage without signs of inflammation:

A
  • symptoms are intermittent
  • related to mechanical deformation
  • signs of irritability when nerve root or spinal nerve is compressed or placed under tension
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23
Q

Subacute stage

A

(4 to 12 weeks)

-certain movements and postures provoke symptoms, including some IADLS

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24
Q

Chronic stage

A

(more than 12 weeks)

-emphasis is placed on returning the patient to high-level activities

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25
Q

Acute Spinal Problems/Protection Phase

A

Patient education
Symptoms relief or comfort
Kinesthetic awareness of safe postures and effects of movement
Core muscle activation and basic stabilization
Basic functional movements

26
Q

Subacute Spinal Problems/Controlled Motion Phase

A 
Pain management
Kinesthetic training
Stretching/mobilization 
Muscle performance
Cardiopulmonary conditioning
Postural stress management and relaxation exercises
Functional activities
27
Q

Chronic Spinal Problems/Return to Function Phase

A 
Emphasize spinal control during high intensity and repetitive activities
Increased mobility
Improved muscle performance
Increased cardiopulmonary endurance
Patient education
28
Q

What constitues patient education in chronic spinal problems?

A

Posture correction
Safe-progression to high-level or high-intensity activities
Self-maintenance and healthy exercise habits

29
Q

What exercises of skills that all patients with spinal impairments should learn:

A

Kinesthetic training
Stabilization training
Functional training

30
Q

Kinesthetic training:

A

Awareness and control of safe spinal motion
Awareness of neutral spinal position
Awareness of effects of ADLs and extremity motion on the spine

31
Q

Stabilization training:

A

Core muscle activation and sustained contraction

Global muscle control of spinal posture with extremity loading

32
Q

Functional training

A

Log roll supine to prone, prone to supine
Supine to side-lying to sitting and return
Sit to stand and return
Walking

33
Q

Patient education:

A

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

34
Q

Indications for spine surgery:

A

Relief of pain related symptoms with disc disease
Management of fractures
Management of hypermobile spinal segments
Management of deformities
Removal of tumors

35
Q

Anterior surgical approach for ACDF:

A

C3-C7 for cervical approach

thyroid, trachea, esophagus

36
Q

Anterior retroperitoneal approach:

A

lumbar spine

37
Q

Posterior approach

A

lumbar spine

38
Q

Indications for surgery for discectomy and microdiscetomy

A

Upper or lower extremity radiculopathy due to nerve root irritation that have failed conservative measures

39
Q

Removal of disc fragments and herniated disc material

A

-compressing the adjacent nerve root

40
Q

Microdiscectomy:

A

Procedure purpose is the same as discectomy

Performed through a smaller incision under greater magnification

41
Q

Laminectomy:

A

May accompany discectomy

Spinal lamina is removed for greater exposure of a nerve root; ligamentum flavum also removed

42
Q

Corpectomy:

A

removal of part of vertebral body

43
Q

Disadvantage of laminectomy:

A

exposure of spinal cord

44
Q

When is fusion indicated?

A

Pt. presents with axial pain combined with instability, arthritic changes, or uncontrolled peripheral pain

45
Q

Types of fusion

A

ACDF
TLIF
Platysma and longus coli muscles are interrupted

46
Q

Vertebroplasty

A

Injectable substance (Polymethylmethacrylate) permeates cancellous bone
Stabilization
‘Internal casting’

47
Q

Kyphoplasty

A

Balloon insertion

Injection of PMMA

48
Q

What is a drawback of vertebroplasty?

A

Lack of height restoration and deformity restoration

49
Q

What are compression fracture treatment?

A

kyphoplasty and vertebroplasty

50
Q

Scoliosis Correction

A

Installation of hardware to correct spinal deformity

Performed when Cobb angle is > 40 degrees

51
Q

Complications with C-spine surgeries:

A

Paralysis
Recurrent laryngeal nerve impairment
Speaking volume diminished
Hoarseness

52
Q

Complications with all spine surgeries

A 
Paralysis
Infection
Dural tear with CSF leak
Non-union
Radiating pain
General surgical complications: DVT, pneumonia
53
Q

What is important to emphasize after surgery?

A 
Early mobility
Precautions
Bending, twisting, lifting
Body Mechanics education
Bracing
Transfers: 
Log Rolling
Walking program
Incision inspection
54
Q

Incision Inspection:

A 
rubor (redness)
Calor (heat)
dolor (pain)
tumor (swelling)
functio laesa (loss of function)
55
Q

Maximum Protective Phase:

A
  • patient education
  • would management & pain control (inspection)
  • bed mobility
  • bracing
  • exercises
  • contraindications
56
Q

Bracing:

A

Philadelphia collar for ACDF

TLSO or LSO for TLIF

57
Q

What exercises are avoided in maximum protective phase?

A
  • extension for patient’s having undergone laminectomy
  • twisting
  • encourage internal bracing of abdomen
  • lifting within appropriate limits
58
Q

Moderate and Minimum Protective Phases:

A
  • scar tissue mobilization
  • progressive stretching and joint mobilization
  • muscle performance
  • gait training
  • contraindications
59
Q

What stretching and joint mobilizations are done in the moderate and protective phases?

A

Gentle (Grade 1 and 2) joint techniques at adjacent segments to surgical site
Pain modulation
ROM

60
Q

What muscle performance is done in the moderate and protective phases?

A

Segmental to global stabilization
Patient goals for activity return
Single plane to multi-planar movements

61
Q

What gait training is done in the moderate and protective phases?

A

Postural neutrality

62
Q

What are the contraindication in the moderate and minimum phases?

A

Mobilizations on the level(s) of the fusion

Extension exercises for patients having undergone a laminectomy

Acute (16 decks)

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