Surgical Considerations For Lumbar (2)

Question 1

What are the four indications for lumbar spine surgery?

Answer 1

Lower extremity radiculopathy

Failed conservative management

Trauma

Red flags- cauda equina syndrome

Question 2

What are epidural injections used for?

Answer 2

Conservative care (to see how a patient would respond to surgery)

Question 3

What are epidural injections used for?

Answer 3

Lumbar disc herniation

Degenerate disc disease

Spinal stenosis

Synovial cyst

Annular tears

Question 4

What type of procedure is a lumbar discectomy?

Answer 4

Minimally invasive

Question 5

What is removed in a lumbar discectomy?

Answer 5

Disc material

Question 6

What is the recovery in a lumbar discectomy?

Answer 6

Quick (return to work 1-2 weeks)

Question 7

What should be avoided after a lumbar discectomy?

Answer 7

Loaded flexion during first 6 weeks (avoid increased sitting)

Question 8

What are indications of a lumbar laminectomy?

Answer 8

Disc herniation and spinal stenosis

Question 9

What is removed in a lumbar laminectomy?

Answer 9

Spinous process

Lamina

Ligamentum flava

Disc material

Question 10

What is retained in a lumbar laminectomy?

Answer 10

Segmental mobility but loss of stability

Question 11

What should be avoided in a lumbar laminectomy?

Answer 11

BLT for 3 weeks

No lifting for 12 weeks

Question 12

What are the reoperation rates of a lumbar laminectomy?

Answer 12

14-38%

Question 13

What are the indications of lumbar interbody fusion?

Answer 13

Pain

Instability

Severe degenerative changes

Peripheral pain

Question 14

What is removed in a lumbar interbody fusion?

Answer 14

Spinous process

Lamina

Disc (replaced with cage or bone graft)

Question 15

What is lost in a lumbar interbody fusion?

Answer 15

Segmental mobility

Question 16

How long do postoperative restrictions last in a lumbar interbody fusion?

Answer 16

Up to 6 months

Question 17

What are the reoperation rates in a lumbar interbody fusion?

Answer 17

8-14%

Re fusion rates 70-96%

Question 18

What is the patient education for post operative management of the max protection phase?

Answer 18

Surgical procedure

Expectations of the surgeon

Rehab

Patient restrictions

Question 19

What is the wound management and pain control for post operative management of the max protection phase?

Answer 19

Look for signs of inflammation like redness, swelling, or nonclosure of wound

Question 20

What is the bed mobility for post operative management of the max protection phase?

Answer 20

Patient must relearn how to perform bed mobility and may wear a spinal orthosis that limits movement

Question 21

What is bracing for post operative management of the max protection phase?

Answer 21

May wear a brace for up to 3 months to promote healing

Question 22

What are the exercises for post operative management of the max protection phase?

Answer 22

Walking and gentle ROM that can be completed in supine

Question 23

What should you avoid if you have a laminectomy?

Answer 23

Excessive extension

Question 24

What is scar tissue mobilization in postoperative management of mod to min protection phase?

Answer 24

To improve connective tissue mobility and decrease pain at surgical site

Question 25

What is muscle performance in postoperative management of mod to min protection phase?

Answer 25

Increase stabilization and begin with single plane exercise and then progress

Question 26

What is gait training in postoperative management of mod to min protection phase?

Answer 26

Use assistive device if needed and facilitate an erect posture

Question 27

What disabilities will PTs deal with post operation?

Answer 27

Muscle control

Pain

Disability

ROM

Psychological issues (depression)

Question 28

What is the likelihood of getting a spine surgery in the US compared to the UK?

Answer 28

5x

Question 29

How many people have persistent pain following lumbar surgery?

Answer 29

1 in 4