Spine Surgery Flashcards
What are the common Consideration for rehab around the spine
Restrictions: Active/ Passive ROM
ROM limits
WB status
What are issues that complicate descision?
Many peripheral joints affect the spine through movement or muscle forces Peripheral nerves Spinal cord Bladder Psychology
What are the three main surgies we learnt about
Lumbar arthroscopic disectomy (micro or partial)
Lumbar spine fusion
ANterior certical Disectomy with fusion
When is a mini disectomy performed
When there is herniation of discs
Indications for lumbar arthroscopic disectomy
Posterolateral disc protrusion/ herniation
Nerve root symptoms (weakness and numbness)
Imaging and clinical findings must correlate
What are the contraindications for Lumbar arthroscopic disectomy?
Lack of clear diagnosis, anatmic level of lesions and radiograhic evidence of NHP
Lack of trial of non operative treatment
Disabilities with major non organic components
Systemic disease process can negatively influence surgery
Medication contarindications
Disc herniation at level of instability
What gets cut/ sawn/ stitched in a lumbar disectomy
Skin incision
Subperiosteal elevation - pull of muscles attache to periosteum
Find interlaminar interval with exposure to the upper and lower lamina
Remove several milimeters of cephalad lamina and 2-3 mm of the medial edge of inferior facet
Ligamentum flavum freed from attachment
bony resection of medial edge of superior facet
What are the complications of Lumbar disectomyies
Dural tears, neural injury, visceral injery, post op infection, recurrence of herniations, in adequate decompression and latrogenic instability
List the goals of Phase 1 - 1-3 weeks after surgery
Protect surgical site
maintain nerve root mobility
Educate patient and minimise fear and apprehension
establish good body mechanics
What do yu do day one post op lumbar disectomy
Initial patient assessment Bed monility Transfer training Gait training Beginning exercise program
What occurs week one post op?
Protective rest, progressive ambulation, appropriately limited actions
WHat is the physiotherapy role in post op recovery pattern for lumbar discectomy?
At 4 weeks after surgery primary stabilisation exercise and mobilisation are begun
When do athletes return to normal activities after lumbar discectomy?
Usually 8 weeks after surgery
WHat is the process for assessment and intervention for spinal surgery
Cest, circulation (DVT’s), mobility, other joints/ limbs and then the spine
What are the indications or lumbar spine fusion
Painful degenerative disc disease
Mechanical lumbar instability
What is the absolute prerequisite for successful lumbar surgery
Outcome should be matching patients symptoms with the appropriate surgical procedure
What gets cute/ sawn/ stitched in Lumbar fusion
Scrape bone clean Use graft bone to place between surfaces Hold bone still with internal fixators The Bone is what keeps it fused Metal stays in place long term
List the lumbar fusion types
Posterior pedicle screw
Harrington hook/ rods
Lumbar interbody fusion - posterior, transforaminal, anterior, lateral
Interbody cages
What to do on the ward after lumber fusion?
Post op precautions, bed mobility and transfers, initiate postop exercises gait training, donning and doffing any required braces, wound care, general overview of prognosis of rehab process
What do you day days 1-5 post lumbar fusions on the ward
Patient education about daily movements
Abdominal stabilisation, neural mobilisation, home care princips.
Phase one actually last 6 weeks. Stay as inpatient for quite a long time
What are the indications for cervical discectomy with fusion?
Cervical spndylosis or degeneration, degenerative disc disease, Radiculopathy, myelopathy - gait abnormalities, hand clumsiness
What is the graft used in Anterior cervical disectomy
its from the ASIS
What are some complications poster anterior cervial discectomy?
Dysphagia, oesophageal injury, neural injury, vascular injuries, postoperative infection, graft/ stabilisation failure, pain, pressure points from bracing
What do you do in the 1-2 weeks post surgery?
Protect surgical site, decrease pain and inflam, maintain UE flexibility, initiate patient enducations regarding neural cervical spine mechanics
how long does it tae for solid consolidation of fusion in cervical spine
6-12 weeks
How long should the cervical dusion/ disectomy patients where a brace for
6-12 weeks
