Surgery

Question 1

Indications for imaging

Answer 1

trauma
midline tenderness
neurological signs and symptoms
congenital spine abnormalities

Question 2

Indications for surgery

Answer 2

fracture/trauma
instability
tumour
myelopathy as a result of central stenosis
lateral stenosis with progressive neurological signs
congenital spinal deformity
failed conservative management with clear patho-anatomical diagnosis

Question 3

Cervical Myelopathy - condition

Answer 3

central canal reduced to 13mm or less
compression of spinal cord

Symptoms - bilateral 
- gait deviation 
- Hoffman test 
- Babinski positive 
- inverted supinator sign positive 
- above 45?
if have 3/5 - very likely have cervical myelopathy

Question 4

Anterior Cervical Dissectomy and Fusion - Process

Answer 4

removes disc to decompress the spinal cord

replaced with autograft, allograft or a man made cage

Question 5

Anterior Cervical Dissectomy and Fusion - Complications

Answer 5

Non-specific

• DVT
• infection
• bleeding
• pulmonary embolism
• GA

Specific

• laryngeal nerve impacted
• oesophageal perforation
• SCI
• non-union
• adjacent segment disease

Question 6

Anterior Cervical Dissectomy and Fusion - Indications

Answer 6

myelopathy as a result of central canal stenosis
lateral stenosis with progressive neurological signs
failed conservative management with clear patho-anatomical cause

Question 7

Anterior Cervical Dissectomy and Fusion - Post Op Care

Answer 7

D1-10

• educate on loading
• address contributing factors (posture, weight bearing)
• encourage pain free movement
• pain meds

Week 2
- objective assessment AROM, PPIVM, neuro integrity, neurodynamics, DNF activation, remote factors

Week 4 - control it phase
- no extension

Week 6-8

• surgeon review
• start extension exercises
• load it

Question 8

Arthroplasty - Process

Answer 8

disc replacement

Question 9

Arthroplasty - Indications

Answer 9

younger people
flexibile spine
between C3-7
trauma

Question 10

Arthoplasty - Complications

Answer 10

sore throat 
dysphagia 
hoarseness
voice disturbances 
infection 
vertebral artery injury

Question 11

Arthroplasty - Post op instructions

Answer 11

D1-10

• educate on loading
• address contributing factors (posture, weight bearing)
• encourage pain free movement
• pain meds

Week 2
- objective assessment AROM, PPIVM, neuro integrity, neurodynamics, DNF activation, remote factors

Week 4 - control it phase
- no extension

Week 6-8

• surgeon review
• start extension exercises
• load it

Question 12

Laminectomy with Fusion - process

Answer 12

complete removal of lamina from posterior direction
increases space
most invasive - chosen for older patients
where lots of spurring, compresses space

Question 13

Laminectomy with Fusion - indications

Answer 13

multilevel cervical myelopathy

lose lots of cervical lordosis and range

Question 14

Laminectomy with Fusion - Post Op instructions

Answer 14

D1-10

• educate
• address contributing facotrs
• pain meds

Week 2-6

• surgeon review
• subjective and objective assessment
• improve ROM
• find it
• UL exercises no weight

Week 6-12

• control it phase- no extension
• UL exercise with load

Week 12-24

• surgeon review
• increased load

Question 15

Types of Trauma - Surgery

Answer 15

Jefferson Fracture - fracture to C1

• result of compression or hyperextension
• unstable = surgical fusion of joint
• stable = cervicothoracic brace

Transverse Ligament damage

• flexion trauma
• can be torn in middle or avulses
• avulsion = halo brace
• torn = atlantoaxial fusion