UVMMC cervical surgery protocol

Question 1

cervical surgeries:

Answer 1

fusions
disc replacements
decompressions

Question 2

pre-op phase:

Answer 2

1 pre-op visit

1-2 weeks prior to surgery

Question 3

pre-op visit goals:

Answer 3

assess etiology and onset of symptoms

physical exam:
> motion (cervical and UE), strength, neurological screen

develop goals both rehab and personal:
> work
> lesisure
> sport

education and answer questions regarding surgery expectations:
> reinforce pre-op instructions
> incision care - able to shower 5 days post
> pain management
> post op precautions

Question 4

phase I:

Answer 4

day 1 post-op to weeks

4 weeks post op: decompressions/disc replacements/1-2 level anterior fusions

6 weeks post op: 3+ level fusions/posterior fusions/trauma surgical interventions

Question 5

phase I goals:

Answer 5

incision/wound management

protection of surgical site/spine

pain management

return to self-care and ADL’s

increase sitting tolerance to 30-45 minutes

walk short duration 3-5 minutes - 2-3x a day as able

return to driving once comfortable and safe to do so (recommend to be off pain narcotics)

gradually return to light duty job = IF SURGEON agrees

Question 6

phase I precautions (discharge instructions leaving hospital):

Answer 6

no lifting greater than 10 pounds

refer to anything specific surgeon told you

good body mechanics - keep objects close to body

be aware of positions that trigger or worsen symptoms - arms overhead

normal to experience symptoms similar to pre-op even on opposite side

Question 7

phase I activity:

Answer 7

walk daily - starting with 3-5min a few times a day

return to basic personal care

return to light house chores

return to work dependent on physical demands of job and physician advice

change positions frequently by alternating supported sitting, standing, and lying down

pillows to support neck and head - keep spine in a good pisiton

Question 8

first PT post-op visit:

Answer 8

2 weeks post for anterior 1-2 level fusion, disc replacement, decompression

3 weeks post for trauma based surgeries, 3+ level fusions, posterior approach fusions

Question 9

first PT post-op visit goals:

Answer 9

if no PT pre-op visit -> assess etiology and onset of symptoms

physical exam as tolerated
> assess incision
> neuro screen
> gait screen
> ROM
> strength
> balance

assess/address functional goals which may have been set at pre-op visit

education:
> incision care
> surgery site/spine protection/pain management
- use of ice
- home TENS unit

determine need of more structured rehab

Question 10

phase II:

Answer 10

starts 4 weeks post for 1-2 levels/decompression/disc replacements

starts 6 weeks post for 3+ levels/trauma surgeries/posterior approach

Question 11

phase II goals:

Answer 11

gradual return as tolerated

return to light-medium level house chores

return to light-medium work level job tasks at paced tolerance rate

start training for GRADUAL return to recreation/leisure/sport activity depending on activity and surgery

Question 12

phase II precaution/activity:

Answer 12

use of good body mechanics with all activities

work on improving motion and mobility

start a strengthening program with cervical isometrics optional

caution patient about higher level activities and need of a gradual return or recommendation for rehab

Question 13

second PT post-op visit:

Answer 13

2 weeks post for anterior 1-2 level fusion, disc replacement, decompression

3 weeks post for trauma based surgeries, 3+ level fusions, posterior approach fusions

Question 14

second PT post-op visit goals:

Answer 14

incision assessment for continued healing

assess changes in symptoms

physical exam

assess knowledge of self-care to determine needs in pain and prevention strategies

assess any return to function

determine need of starting a more structure rehab program/consistent PT

use neck disability index

Question 15

phase III:

Answer 15

starts 6-12 weeks post for 1-2 levels/decompression/disc replacements

starts 12+ weeks post for 3+ levels/trauma surgeries/posterior approach

more consistent rehab/skilled PT depends on pt’s continued needs and specific goals

Question 16

goals: progression during phase III

Answer 16

return to prior activities, focused on personal goals and training towards
- work
- sports
- recreation/leisure

Question 17

phase III precautions:

Answer 17

no precautions unless specified by the surgeon

emphasis on gradual return to activity

Question 18

exercises one to two days after surgery:

Answer 18

2-3x a day

diaphragmatic breathing
shoulder rolls
shoulder blade push down
across body shoulder stretch
hamstring stretch

Question 19

sitting positions:

Answer 19

sit with back supported

lumbar pillow support or towel

shoulders relaxed and avoid rounded back

Question 20

sleeping positions:

Answer 20

lie on back = pillow under knees and thin pillow under head

lie on side = pillow between knees and thicker pillow under head

neck support out of a rolled towel - around neck

Question 21

post-op rehab plan

Answer 21

first post-op PT visit = 2-3 weeks out

second post-op PT visit = 4-6 weeks out

Question 22

phase I exercises

Answer 22

shoulder rolls
doorway stretch
across body shoulder stretch
upper back stretch
trunk rotation stretch
shoulder blade pinches
standing tall

walking program - 5-15 minutes 3x a day - build gradually to 30-40 minutes

Question 23

phase II exercises

Answer 23

arms overhead stretch
row with band
straight arm pull back
wall push up
wall angels

Question 24

phase III exercises

Answer 24

choose two to start and wait 3-4 days before adding any more

pull out with band
bent over row
counter height push ups
band pull put shoulder height
cat-cow stretch
bird dog