Surgical Considerations For Lumbar (2) Flashcards
What are the four indications for lumbar spine surgery?
Lower extremity radiculopathy
Failed conservative management
Trauma
Red flags- cauda equina syndrome
What are epidural injections used for?
Conservative care (to see how a patient would respond to surgery)
What are epidural injections used for?
Lumbar disc herniation
Degenerate disc disease
Spinal stenosis
Synovial cyst
Annular tears
What type of procedure is a lumbar discectomy?
Minimally invasive
What is removed in a lumbar discectomy?
Disc material
What is the recovery in a lumbar discectomy?
Quick (return to work 1-2 weeks)
What should be avoided after a lumbar discectomy?
Loaded flexion during first 6 weeks (avoid increased sitting)
What are indications of a lumbar laminectomy?
Disc herniation and spinal stenosis
What is removed in a lumbar laminectomy?
Spinous process
Lamina
Ligamentum flava
Disc material
What is retained in a lumbar laminectomy?
Segmental mobility but loss of stability
What should be avoided in a lumbar laminectomy?
BLT for 3 weeks
No lifting for 12 weeks
What are the reoperation rates of a lumbar laminectomy?
14-38%
What are the indications of lumbar interbody fusion?
Pain
Instability
Severe degenerative changes
Peripheral pain
What is removed in a lumbar interbody fusion?
Spinous process
Lamina
Disc (replaced with cage or bone graft)
What is lost in a lumbar interbody fusion?
Segmental mobility
How long do postoperative restrictions last in a lumbar interbody fusion?
Up to 6 months
What are the reoperation rates in a lumbar interbody fusion?
8-14%
Re fusion rates 70-96%
What is the patient education for post operative management of the max protection phase?
Surgical procedure
Expectations of the surgeon
Rehab
Patient restrictions
What is the wound management and pain control for post operative management of the max protection phase?
Look for signs of inflammation like redness, swelling, or nonclosure of wound
What is the bed mobility for post operative management of the max protection phase?
Patient must relearn how to perform bed mobility and may wear a spinal orthosis that limits movement
What is bracing for post operative management of the max protection phase?
May wear a brace for up to 3 months to promote healing
What are the exercises for post operative management of the max protection phase?
Walking and gentle ROM that can be completed in supine
What should you avoid if you have a laminectomy?
Excessive extension
What is scar tissue mobilization in postoperative management of mod to min protection phase?
To improve connective tissue mobility and decrease pain at surgical site
