Spine and Pelvis Flashcards
When is spinal surgery indicated
Extended period of unsuccessful physio
conservative managment isn’t successful
spinal fractures
bone cancer
pinched nerves - compressed nerves causing radicular pain/radiculopathy
Types of spinal surgery
Decompression
Discectomy: remove part / all of disk
Fusion
Total disc replacement
Indications for an ACDF (anterior cervical discectomy and fusion)
Absolute indications
- progressive cervical myelopathy
- certain infections
- traumatic instability
Relative indications
- radiculopathy that has failed conservative treatment for 6 weeks
- recurrent radiculopathy
- progressive neurological deficits
- severe pain
factors that may affect bone remodeling for ACDF
smoking
age
nutrition
comorbidities
steroid use
radiation
chemo
ACDF post op: day 0-14
may use cervical collar
don’t:
- pick up anything heavier than 1.5L
- sleep with arms over head or on stomach
- lift anything above shoulder
- spend all time in bed
- perform strenuous exercises
- get surgical site wet until healed
gradually increase walking time
avoid infection
goals to reduce pain/swelling, gradual return to walking
Post op ACDF: Day 15-21
improve tolerance of activity
restore ROM in UL
restore patient independence with self care skills/ADLs
improve CV function
independent with home exercise program
gentle stretching of chest
gentle UL ROM
progress walking
Post op ACDF: Day 22-60
increase UL strength and endurance
improve mobility of thoracic spine
Physio:
- PROM of shoulder
- AROM of Cspine
- progressive resistance exercises below 90
- gentle thoracic mobilisations
- training DNF
Post op ACDF: Day 61-84
restore strength to Cspine
improve scapula-thoracic mechanics
physio
- isometrics for Cspine
- gentle UL strengthening above shoulder height
- progressive resistance exercises
- scap exercises
Post op ACDF: Day 85-360
return to prior level of functioning
progress UL resisted exercises
Functional retraining activities for work or sport
Indications for lumbar spine surgery
similar to ACDF
severe pain
unstable fracture
progressive sponylolisthesis
Lumbar Spine fusion Surgery: Day 1-5 –> week 6
precautions
- no bending, lifting, twisting
- no prolonged sitting >30-60 min
- limit pushing, pulling, bending
- avoid driving
teach log roll
assistive device use for ADL training
lumbar spine fusion Weeks 6-10
progress walking tolerance to 20-30 mins
functional exercises: wall slides, side lying hip rotation, standing rows/presses
initiate light strengthening exercises
stretch hips, LL, shoulders
initiate gentle balance activities
lumbar spine fusion post op: weeks 11-19
progress walking to 30-60
progress function program
- supine marching
- bridging
- squats
- planks
resistance training using weights after 8-10 weeks
CV training
return to work
lumbar spine fusion post op: weeks 20+
work on hip, LL, shoulder flexibility
initiate light lumbar spine flexibility exercise
gym and home program - CV, strength, flexibility
indications of Cauda Equina
urinary retention/incontinence
pain raditating down both legs
severe LBP
sensory loss
