Surgical Procedures for the Spine Flashcards
Cervical spine surgeries are for pt’s who:
- 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
Anterior Cervical Disectomy and Fusion: purpose of surgery
to remove disc herniations and or to relieve spinal cord and nerve root pressure
Anterior Cervical Disectomy and Fusion removes which types of herniations?
lateral and central
95% chance of good/excellent relief from radiating arm pain
numbness usually improves
resum full, unrestricted activity wihtin 3-6 months
Rare complications of Anterior Cervical Disectomy and Fusion
sore throat, hoarseness, difficulty swallowing, failure of bony fusion (bone doesn’t heal), pseudoarthrosis (non-union)
Advantages of Anterior Cervical Fusion
provides stability to motion segment
immoblize painful degenerative disc and facets
disadvantage of anterior cervical fusion
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
Anterior Corpectomy and Fusion
removal of the vertebral body and disc spaces at either end. goal is to decompress cervical canal
Anterior Corpectomy and Fusion performed when?
performed when cervical disease encompasses more than just disc space
- multi level cervical stenosis or spinal cord compression cause by bone spurs
Anterior Corpectomy and Fusion post op
post op rigid cervical orthosis often used
Laminectomy (cervical) is used to treat what
used to treat spinal stenosis
Laminectomy (cervical)
resect lamina on one or both ends
increases axial space for SC
usually done when more than one level is involved
goals of cervical laminectomy
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
complcations of cervical laminectomy
instability due to removing multiple segments
post-laminectomy kyphosis (requires surgical revision)
myofascial pain
occipital headaches
Laminoplasty for who?
indicated for multi-segmental spondylotic myelopathy
superior functional recovery compared to laminectomy for spondylotic myelopathy
what is spondylotic myelopathy
compression of the spinal cord
laminoplasty
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
complcations of laminoplasty
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
Post Surgical PT for cervical spinal surgery
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
Post op brace
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
General pt goals initally after surgery
reduce pain and inflammation prevent post op complications protect surgical site prevent recurrent herniation maintain dural mobility improve fxn minimze effects of immoblization
early return to function post op (cervical surgery) instruct pt in what?
bed mobility, gait, transvers, wound care
early return to function post op (cervical surgery) 1 week
patients are allowed to shower
early return to function post op (cervical surgery) 7-10 days
safe return to sedentary occupational duties but avoid prolonged positions
Out patient PT: begin 2-3 weeks depending on pt and procedure: EXamination
history, inspect wound site, postural exam, neuro exam including neurodynamic and strength testing -myotomes!
out patient PT: Intervention
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
Week 4 post op (cervical)
progressive strenthening exercises for spinal stablilzers
cardo exercises - bike, swim, start 5-10 min and work up to 30-60
6-8 weeks post op PT cervical
jogging allowed if minimal pain
morning activities best because disc is maximally hydrated
12 weeks post op PT cervical
high impact sports allowed and return to manual labor jobs
3 types of diskectomy for lumbar radiculopathy
hemilaminectomy and diskectomy
percutaneous diskectomy
microdiskectomy
2 goals of lumbar surgery for radiculopathy
relieve pain and restore neural function (sensory and motor)
Diskectomy (lumbar) - hemilaminectomy and diskectomy
posterior approach
goal is to treat IVD lumbar
goals of Diskectomy (lumbar) - hemilaminectomy and diskectomy
decompress involved nerve root
minimize scar formation
avoid nerve damage
what is removed in a diskectomy
one side of lamina removed as well as disc
Diskectomy: percutaneous diskectomy
minimally invasive
uses prob for aspiration of nucleus p. material from IVD
Diskectomy: percutaneous diskectomy surgery is for who?
pt’s without stenosis, sever arthritis, or ligamentum flavum hypertrophy
Microdiscectomy
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
surgery that removes part of ligamentum flavum and part of facet?
microdiscectomy
Lumbar Laminectomy
removal of lamina
also removes spinous process and ligamentum flavum above and below the lamina
disadvantage of laminectomy
destablizing effect on the segment
Decompression
laminectomy with partial facetectomy
may include laminoplasty (makes canal larger) or unilateral laminotomy for canal enlargemnt
lumbar fusion: who is it used for
lack of consensus on indications: use for spinal stenosis or DDD with NO herniation or stenosis
lumbar fusion compared to laminectomy w/o fusion
wider surgical exposure/ more extensive dissection and trauma
longer operation time and recovery time
takes longer for bone to heal
lumbar fusion: advantages for recurrent disc herniations:
reduce/elimiate segmental motion
reduce stress on degenerated disc space
reduce incidence of additional herniation at the affected disc space
lubmar fusion:
bone grafts
interbody cages = titanium that bone grows into - goal is to maintain space in SC
plates
pedicle screws
post srugical PT for lumbar
same as cervical - no set guideleines, listen to surgeon
goals of lumbar post op initially
same as cervical
early return to fxn lumbar surgery instructions for pt
bed mobility, gait, transfers, wound care, body mechanics
7-10 days post op lumbar
patients can safely return to sedentary occupational jobs but avoid prologned psotions
no driving for two weeks:
lumbar surgery - surgeon decides when patient can drive
outpatient PT 2-3 weeks after lubmar surgery
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
week 4 post op lumbar
strengthen spinal stabilziers - start in neutral and add extremity movemetns
cardio = bike, swim, start gradual
6-8 weeks post op lumbar
can jog if minimal pain
progressive strengthing/lifting
can return to high impact sports after 12 weeks
complcations following lumbar surgery
infection, poor wound healing, scars, adhesions, venous thromboembolism, pulmonary embolus, weakness or muscle atrophy (LE due to cord impairments), psychosocial problems
