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Semester 3 PM Exam 2 > Surgical Procedures for the Spine > Flashcards

Surgical Procedures for the Spine Flashcards

1
Q

Cervical spine surgeries are for pt’s who:

A
  • for patients with persistent radicular pain who do not respond to conservative measures
  • significant extremity or myotome weakness
  • progressive neuro deficits (worsening over time)
  • severe pain (no position of comfort)
  • pain that lasts beyond a conservative intervention period of 8-12 weeks
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2
Q

Anterior Cervical Disectomy and Fusion: purpose of surgery

A

to remove disc herniations and or to relieve spinal cord and nerve root pressure

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3
Q

Anterior Cervical Disectomy and Fusion removes which types of herniations?

A

lateral and central
95% chance of good/excellent relief from radiating arm pain
numbness usually improves
resum full, unrestricted activity wihtin 3-6 months

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4
Q

Rare complications of Anterior Cervical Disectomy and Fusion

A

sore throat, hoarseness, difficulty swallowing, failure of bony fusion (bone doesn’t heal), pseudoarthrosis (non-union)

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5
Q

Advantages of Anterior Cervical Fusion

A

provides stability to motion segment

immoblize painful degenerative disc and facets

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6
Q

disadvantage of anterior cervical fusion

A

progression of degenerative changes at other levels – degeneration of other segments can occur b/c fused segment not moving so now other segments have to move more

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7
Q

Anterior Corpectomy and Fusion

A

removal of the vertebral body and disc spaces at either end. goal is to decompress cervical canal

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8
Q

Anterior Corpectomy and Fusion performed when?

A

performed when cervical disease encompasses more than just disc space
- multi level cervical stenosis or spinal cord compression cause by bone spurs

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9
Q

Anterior Corpectomy and Fusion post op

A

post op rigid cervical orthosis often used

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10
Q

Laminectomy (cervical) is used to treat what

A

used to treat spinal stenosis

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11
Q

Laminectomy (cervical)

A

resect lamina on one or both ends
increases axial space for SC
usually done when more than one level is involved

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12
Q

goals of cervical laminectomy

A

progression of SC damage should stop
fxnl return for walking and use of hands - if nerve damage wasn’t too bad and hasn’t already become permanent before surgery done

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13
Q

complcations of cervical laminectomy

A

instability due to removing multiple segments
post-laminectomy kyphosis (requires surgical revision)
myofascial pain
occipital headaches

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14
Q

Laminoplasty for who?

A

indicated for multi-segmental spondylotic myelopathy

superior functional recovery compared to laminectomy for spondylotic myelopathy

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15
Q

what is spondylotic myelopathy

A

compression of the spinal cord

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16
Q

laminoplasty

A

one side of lamina is cut and other side is scored so that canal can be widened. bone is then added to keep canal widened. room for Sc when issue is multi-level

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17
Q

complcations of laminoplasty

A

nerve root injury occurs from surgery in 11% of cases

potentially caused by the cord moving posteriorly after surgery, causing traction and damage to the nerve root

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18
Q

Post Surgical PT for cervical spinal surgery

A

no set guidelines for specific surgeries
protocols vary - listen to surgeon, consider bone healing time! especially in fusion pt’s - bone takes a long time to heal; may not see pt’s for a few months post op

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19
Q

Post op brace

A

used after discetomy and corpectomy
brace for first few weeks or months
padded plastic neck brace or cervicothoracic brace (CTO)
reduces pain and stress on neck
improves bone healing by maintaining neck in rigid position

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20
Q

General pt goals initally after surgery

A 
reduce pain and inflammation
prevent post op complications
protect surgical site
prevent recurrent herniation
maintain dural mobility 
improve fxn
minimze effects of immoblization
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21
Q

early return to function post op (cervical surgery) instruct pt in what?

A

bed mobility, gait, transvers, wound care

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22
Q

early return to function post op (cervical surgery) 1 week

A

patients are allowed to shower

23
Q

early return to function post op (cervical surgery) 7-10 days

A

safe return to sedentary occupational duties but avoid prolonged positions

24
Q

Out patient PT: begin 2-3 weeks depending on pt and procedure: EXamination

A

history, inspect wound site, postural exam, neuro exam including neurodynamic and strength testing -myotomes!

25
Q

out patient PT: Intervention

A

educate on posture and body mechanics, gentle ROM (may be UE and LE to start and ROM of neck later - start w/ eye mvmts), submax isometrics, avoid heavy lifting 4-6 weeks
electrotherapeutic modalities, physical agents, scar massage

26
Q

Week 4 post op (cervical)

A

progressive strenthening exercises for spinal stablilzers

cardo exercises - bike, swim, start 5-10 min and work up to 30-60

27
Q

6-8 weeks post op PT cervical

A

jogging allowed if minimal pain

morning activities best because disc is maximally hydrated

28
Q

12 weeks post op PT cervical

A

high impact sports allowed and return to manual labor jobs

29
Q

3 types of diskectomy for lumbar radiculopathy

A

hemilaminectomy and diskectomy
percutaneous diskectomy
microdiskectomy

30
Q

2 goals of lumbar surgery for radiculopathy

A

relieve pain and restore neural function (sensory and motor)

31
Q

Diskectomy (lumbar) - hemilaminectomy and diskectomy

A

posterior approach

goal is to treat IVD lumbar

32
Q

goals of Diskectomy (lumbar) - hemilaminectomy and diskectomy

A

decompress involved nerve root
minimize scar formation
avoid nerve damage

33
Q

what is removed in a diskectomy

A

one side of lamina removed as well as disc

34
Q

Diskectomy: percutaneous diskectomy

A

minimally invasive

uses prob for aspiration of nucleus p. material from IVD

35
Q

Diskectomy: percutaneous diskectomy surgery is for who?

A

pt’s without stenosis, sever arthritis, or ligamentum flavum hypertrophy

36
Q

Microdiscectomy

A

removal of disc material causing compression or irritaiton of nerve root
greater than 90% success rate
ligamentum flavum and part of facet removed
patients able to return to work or previous activity level
erector spinae muscles stretched during surgery

37
Q

surgery that removes part of ligamentum flavum and part of facet?

A

microdiscectomy

38
Q

Lumbar Laminectomy

A

removal of lamina

also removes spinous process and ligamentum flavum above and below the lamina

39
Q

disadvantage of laminectomy

A

destablizing effect on the segment

40
Q

Decompression

A

laminectomy with partial facetectomy

may include laminoplasty (makes canal larger) or unilateral laminotomy for canal enlargemnt

41
Q

lumbar fusion: who is it used for

A

lack of consensus on indications: use for spinal stenosis or DDD with NO herniation or stenosis

42
Q

lumbar fusion compared to laminectomy w/o fusion

A

wider surgical exposure/ more extensive dissection and trauma
longer operation time and recovery time
takes longer for bone to heal

43
Q

lumbar fusion: advantages for recurrent disc herniations:

A

reduce/elimiate segmental motion
reduce stress on degenerated disc space
reduce incidence of additional herniation at the affected disc space

44
Q

lubmar fusion:

A

bone grafts
interbody cages = titanium that bone grows into - goal is to maintain space in SC
plates
pedicle screws

45
Q

post srugical PT for lumbar

A

same as cervical - no set guideleines, listen to surgeon

46
Q

goals of lumbar post op initially

A

same as cervical

47
Q

early return to fxn lumbar surgery instructions for pt

A

bed mobility, gait, transfers, wound care, body mechanics

48
Q

7-10 days post op lumbar

A

patients can safely return to sedentary occupational jobs but avoid prologned psotions

49
Q

no driving for two weeks:

A

lumbar surgery - surgeon decides when patient can drive

50
Q

outpatient PT 2-3 weeks after lubmar surgery

A

educate on posture and body mechanics, ROM (start with UE), sub max isometrics, arm and leg exercises, no heavy lifting 4-6 weeks
electrotherapeutic modalities, physcial agents, scar massage

51
Q

week 4 post op lumbar

A

strengthen spinal stabilziers - start in neutral and add extremity movemetns
cardio = bike, swim, start gradual

52
Q

6-8 weeks post op lumbar

A

can jog if minimal pain
progressive strengthing/lifting
can return to high impact sports after 12 weeks

53
Q

complcations following lumbar surgery

A

infection, poor wound healing, scars, adhesions, venous thromboembolism, pulmonary embolus, weakness or muscle atrophy (LE due to cord impairments), psychosocial problems

Semester 3 PM Exam 2 (1 decks)

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