Surgical Considerations - General Principles and Anterior Cervical Discectomy and Fusion Flashcards
What are Surgical Considerations for MSK disorders of the Extremities and Spine?
- Incapacitating pain at rest or with functional activities
- Marked limitation of A/PROM
- Gross instability of a joint or bony segment
- Joint deformity or abnormal joint alignment
- Trauma resulting in significant tissue damage
- Significant structural degeneration
- Chronic joint swelling
- Failed conservative (nonsurgical) or prior sugical management
- Significant loss of function leading to disability as the result of any of the preceding factors
Surgical Approaches
What are the Pros and Cons of Arthroscopic approach?
Pros:
- Minimally invasive
- Faster recovery
- Reduced risk of infection
- Less blood loss
Cons:
- Limited view/access of area
- Technically complex
- Risk of iatrogenic lesion
Iatrogenic means caused by a medical professional, treatment, or diagnostic procedure, or by an error or negligence during medical care
Surgical Approaches
What are the Pros and Cons of an Open Approach?
Pros:
- Good view/access of area
- Flexibility with procedure
- Tactile feedback
Cons:
- Larger incision
- Increased risk of tissue trauma
- Slower recovery
- Increased blood loss
Tissue Grafts
What is the difference between Autografts, Allografts and Synthetic Tissue Graft?
Autograft:
- Harvested from body’s own tissue
- Donor site ofen requires protection
Allografts:
Cadaveric Donor
- Can be fresh or cryopreserved
- used when autograft (donor site) is not adequate
- Risk of rejection
Synthetic:
- Polymer, Biodegradabel or metal
- Biodegradable grafts include BEAR graft used for ACL repair
- Metal grafts used for arthroplasties or ORIF
Upper Quarter Surgical Procedures
What are some examples of a Surgical Repair?
- RTC Tendon repair
- UCL repair
- Labral repair
- Flexor/Extensor Tendon (hand) repair
Upper Quarter Surgical Procedures
What are some examples of a Surgical Release/Decompression?
- Subacromial Decompression (SAD)
- Bicep LH Tenotomy
Upper Quarter Surgical Procedures
What are some examples of a Surgical Resection?
- Cervical Laminectomy
- Synovectomy (Subacromial bursa)
Upper Quarter Surgical Procedures
What are some examples of a Surgical Reconstruciton or Replacement?
- Shoulder Arthroplasty
- UCL reconstruction/replacement
- Radial head
Upper Quarter Surgical Procedures
What are some examples of a Surgical Fusion or Fixation?
- Humeral shaft ORIF
- Midcarpal Arthrodesis
Upper Quarter Surgical Procedures
What are some examples of a Surgical Realignment?
- Ulnar Nerve Transposition
- GH Capsular Shift
- Ulnar nerve transposition is surgery to relieve pressure by moving the nerve from behind the elbow to the front.
- A capsular shift is a surgical procedure that tightens the shoulder joint capsule to improve shoulder instability
General Principles
What are sturctures affected by surgery?
Indentify the primary, secondary and tertiary structures
Primary: Bone
Secondary: Capsule/Ligament
Tertiary: Surrounding tissues disrupted by sugery to access the primary site
What are factors that influence the components, progression, and outcomes of a postoperative rehabilitation program?
- Extent of tissue pathology or damage (Size or severity of the lesion)
- Type and unique characteristics of the surgical procedure
- Patient related factors
- Stage of healing of involved tissues
- Characteristics of types of tissues involved
- Integrity of structures adjacent to involved tissues
- Philosophy of the surgeon
What are potential complications following an Anterior Cervical Fusion?
- Dysphagia is the most common post-operative complication (Persistant complications are rare)
- Surgical site infection and wound complication has been cited as the most common complication after surgery
With an Anterior Cervical Fusion, what should take part in the Observation?
Integumentary Examination
- Color
- Skin temp.
- Moisture
- Skin Turgor
- Lesions or skin break down
Extenal device/brace
- Miami J-Collar
(Teach patient how to don/doff the brace)
