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Orthopaedic Physiotherapy > Spine Surgery & Rehab > Flashcards

Spine Surgery & Rehab Flashcards

1
Q

What are some of the spinal complications?

A
  • Peripheral nerves
  • Spinal cord
  • Bladder
  • Psychology
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2
Q

What is the vertebral arch made up of?

A

Pedicle & laminar

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3
Q

What are the indications for lumbar arthroscopic discectomy?

A
  • Posterolateral disc protrusion/herniation
  • Nerve root symptoms (numbness & weakness)
  • Spinal nerve distribution (dermatomes, myotomes)
  • Imaging & clinical findings must correlate
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4
Q

Where do approximately 90% of lumbar herniations occur?

A

L4-L5 & L5-S1

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5
Q

What are the contraindications for lumbar arthroscopic discectomy?

A
  • Lack of clear clinical diagnosis
  • Lack of trial of nonoperative treatment
  • Not a clear lumbar spine issue
  • Systemic disease processes
  • Medical contraindications
  • Disc herniation at level of instability
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6
Q

What are the surgical procedures used as treatment for lumbar disc protrusion?

A
  • Lumbar discectomy
  • Hemi laminectomy & discectomy
  • Laminectomy & discectomy
  • Minimally invasive percutaneous techniques
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7
Q

What are some of the complications of lumbar discectomy?

A
  • Dural tears
  • Neural injury
  • Visceral injuries
  • Postop infection
  • Recurrence of herniation
  • Inadequate decompression
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8
Q

What are the goals of phase 1 post lumbar discectomy?

A

1-3 weeks post surgery

  • Protect surgical site, promote wound healing
  • Maintain nerve root mobility
  • Reduce pain & inflammation
  • Educate
  • Establish good body mechanics for self-care
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9
Q

What are some of the difficulties experienced by patients in phase 1 post lumbar discectomy?

A
  • Difficulty tolerating sustained positioning
  • Incisional pain, esp with flexion
  • Driving not allowed 1-2 weeks
  • Cannot shower for 7 days
  • No loaded lumbar flexion
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10
Q

When can weight bearing motion testing, end of range movements & slump testing be performed post lumbar discectomy?

A

5 weeks post op

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11
Q

Why should patients avoid lumbar flexion in standing & sitting post lumbar discectomy?

A

Intradisc pressures are increased & excessive shear forces occur

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12
Q

What is the post op recovery pattern for lumbar discectomy?

A
  • Walk as tolerated
  • Return to office work 5-10 days
  • Primary stabilisation exercises & mobilisation 4 weeks post op
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13
Q

What are the indications for lumbar spine fusion (arthrodesis)?

A
  • Painful degenerative disc disease is the most prevalent diagnosis
  • Mechanical lumbar instability
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14
Q

What is the prerequisite for successful lumbar surgery outcome?

A

Matching patient symptoms with the most appropriate surgical procedure

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15
Q

What are the goals of phase 1 post lumbar fusion?

A

Up to 6 weeks post op

  • Patient education about daily movements
  • Abdominal stabilisation
  • Neural mobilisation
  • Home care principles
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16
Q

What are the indications for cervical discectomy with fusion?

A
  • Cervical spondylosis or degeneration
  • Degenerative disc disease (axial neck pain, neck stiffness, headaches)
  • Radiculopathy (symptoms of arm pain with deficits in UEs)
  • Myelopathy (gait abnormalities, hand clumsiness, UMN signs)
17
Q

What are the complications of anterior cervical discectomy?

A
  • Dysphagia
  • Oesophageal injury
  • Neural injury
  • Vascular injuries
  • Post op infection
  • Graft/stabilisation failure
  • Pain
  • Pressure points from bracing
18
Q

What are the goals of phase 1 post anterior cervical discectomy?

A

1-2 weeks post op

  • Protect surgical site
  • Decrease pain & inflammation
  • Maintain UE flexibility
  • Movement & gliding of nerves, but not stretching
  • Initiate patient education
19
Q

How long does solid consolidation of fusion post anterior cervical discectomy require?

A

6-12 weeks

20
Q

What is the post op recovery pattern for anterior cervical discectomy?

A
  • Excessive motion & loading discouraged
  • Assessment of cervical ROM & UE strength not appropriate in phase 1
  • Wear rigid collar for 6-12 weeks
21
Q

What tissues are cut in a lumbar discetomy?

A
  • Skin
  • Muscles lifted of periosteum
  • Lamina
  • Inferior facet
  • Ligamentum flava, nerve root sleeve & epidural fat retracted
  • Disc herniation
22
Q

What tissues are cut in a lumbar fusion?

A
  • Skin
  • Surfaces of bone scraped clean
  • Bones held still with internal fixators while graft bone union forms

Orthopaedic Physiotherapy (11 decks)

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