Week 3- Orthopaedic Management of the Spine (Elective & Trauma) Flashcards

1
Q

What are elective spine surgeries

A
  • discectomy
  • laminectomy/decompression
  • fusion
  • corrective surgeries eg scoliosis in children
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2
Q

What are traumatic spine surgeries

A
  • fractures

- displacements/dislocations

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3
Q

What is a discectomy

A
  • removal of part or complete herniated disc impacting on spinal nerves
  • aka microdiscectomy
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4
Q

What are what are the indications for discectomy

A

Absolute:
-spinal cord compression: Caudia equinae

Relative:

  • spinal nerve root compression: radiculopathy
  • radiological imaging
  • failure of non-operative treatments
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5
Q

What are additional procedures to a discectomy/ microdiscectomy

A
  • Fusion

- artificial disc replacement

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6
Q

What are post op aims for a discectomy

A
  • independent mobility, log roll
  • good posture and spinal mechanics
  • independent PDLs
  • gradual sitting protocol as pain allows (check notes to see otherwise)
  • limited lifting
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7
Q

What is a laminectomy

A
  • also known as decompression
  • removal of the laminate to enlarge the spinal canal to relieve pressure on the spinal cord or nerves
  • lminotomy/foraminotomy: removal of a small portion of the laminate and ligaments, usually unilateral (decreases postoperative spinal instability)
  • indications: spinal sternosis
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8
Q

What is the post op of a laminectomy?

A
• Check post op instructions
• Commonly Protocol 
• Aims:
-Independent mobility, log roll
- Good posture and spinal mechanics – minimize lumbar flexion and extension
- Independent PDLs 
- Limited lifting
• 70 - 80% Patients positive outcomes
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9
Q

Describe a fusion including the indications

A
• Fuses 2 or more vertebral bodies together
• Aim – restrict spinal motion and remove the source of mechanical back
pain to relieve symptoms 
• Indication:
- Trauma
- Revisions
- Tumour
- Segmental degeneration
- Deformity
- Spondylolisthesis
- Spondylolysis
- Degenerative disc disease
- Recurrent disc herniation
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10
Q

Post op of a fusion

A
• Check post op instructions
• Commonly Protocol 
• Aims:
- Independent mobility, log roll
- Good posture and spinal mechanics – may have corset brace
- Independent PDLs
- Limited lifting
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11
Q

What are outcomes for a fusion

A

-varying
-dependent on patient selection
-higher success with:
• Motivated patients to return to work/function
• Patient without history of: Psychological issues and No litigation, workers compensation, or disability issues

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12
Q

What are the conditions where corrective surgeries are done?

A
  • scoliosis: idiopathic, neuromuscular/ myelomeningocele
  • lordosis/ kyphosis
  • juvenile ankylosis spondylitis
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13
Q

What are indications for corrective surgeries

A
  • fixed deformity
  • stability of spine is compromised
  • neurological deficit
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14
Q

What are the procedures for corrective surgeries

A
  • osteotomy
  • decompression
  • fusion
  • rods: magic grow rod, shilla procedures
  • vertebral body stapling
  • vertebral body tethering
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15
Q

When do you suspect a spinal injury?

A

Protection is priority, Detection is secondary

  1. Immobilise on rigid board- start spinal rules
  2. Apply rigid collar
  • think about mechanism of injury —> fall/heavy load/bending/impact/RTA
  • suspect in all unconscious patients —> they can’t tell you if they have any spinal pain
  • presence of any neurological red flags
  • any spine pain or tenderness —> however if no pain you can’t necessarily rule out injury
  • don’t forget other injuries: beware the “distracting injury”
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16
Q

What is the Canadian C-Spine rule

A
  • highly sensitive, reliable
  • alert, stable, recent trauma: ? X-ray/CT
  • not applicable in unstable patient, acute paralysis, known vertebral disease, prev CSp surgery, paediatrics, pregnant
17
Q

Cervical fractures

A

• Usually the result of high energy trauma
• 80% 18-25yr old, Male to Female 4:1
• Suspected injury? Assume & immobilise until cleared
• May be associated with head injury
- Blunt head injury: suspect C1-3 involvement
• Needs neuro examination
• Paeds = C2/3, Adult = C5/6/7
• 5-10% unconscious MVA/Fall patients – CSp #

18
Q

What is the management of a A0, minor, non-structural fracture

A

Soft collar

19
Q

What is the management of A!, compression # single end plate

A
  • soft collar/ spinal precautions: unconscious pts
  • halo if pt not suitable for surgery
  • surgery: anterior plating
20
Q

What is the management of A2, coronal split/ pincer fracture

A
  • soft collar/ spinal precautions: unconscious pts
  • halo if pt not suitable for surgery
  • surgery: anterior and posterior plating
21
Q

What is the management of A3, burst fracture of single end plate

A
  • soft collar/ spinal precautions: unconscious pts
  • halo if pt not suitable for surgery
  • surgery: anterior and posterior plating
22
Q

What is the management of A4, burst fracture or sagittal split involving both endplates

A
  • soft collar/ spinal precautions: unconscious pts
  • halo if pt not suitable for surgery
  • surgery: anterior and posterior plating
23
Q

What are thoracolumbar fracture

A

• Usually the result of high energy trauma
- 40% MVA, 20% falls, 40% GSW/sport/occupational
• Pathological fractures
• Suspected injury? Assume & immobilise until cleared
• Mod-severe pain, worse with movement
• Needs neuro examination
• May have additional other injuries  abdo
• Tx/Lx # + SCI involvement = 10-38% of #, 50-60% of #/Dislocation

24
Q

What is the management of a thoracolumbar fracture

A

A0-minor, non-structural fractures
-brace: TLSO

A1 wedge/ compression #
-brace: TLSO

A2 coronal split/ pincer fracture

  • brace: TLSO
  • surgery: anterior and posterior plating with pins

A3 burst fracture of single end plate

  • brace: TLSO
  • surgery: anterior and posterior plating pedicle screws

A4 burst fracture or sagittal split involving both endplates

  • brace: TLSO
  • surgery: anterior and posterior plating with pedicle screws

B1 transosseous tension band disruption/ chance fractures
-surgery: posterior segment fixation with pedicle screws/ Schwann pins

B2 posterior tension band disruption
-surgery: anterior stabilisation (neural or disc damage) and posterior segment fixation with pedicle screws/ schnauzer pins

B3 Hyperextension
-surgery: anterior stabilisation (neural or disc damage) and posterior segment fixation with pedicle screws

C displacement or dislocation
-surgery: anterior stabilisation (neural or disc damage) and posterior segment fixation with pedicle screws

25
Q

What are different types of braces

A
  • Miami-J
  • Lermann- Minerva C3-T5
  • Miami JTO C6-T5
  • CASH/Jewett T7-L3
  • TLSO T7-L4
  • Philadelphia collar C3-6
26
Q

What are Physiotherapy managements of spinal fractures

A
  • Braces
    • usually mobilised WBAT the day of brace application
    • lying ↔ standing through side lying and perching is recommended
    • Educate re: injury & expectations, warnings re-brace, doning and
    doffing brace, ADL’s, avoid heavy lifting,/jumping/sustained flexion
    for 6 weeks
    • MDT referrals
  • Surgery
    • usually mobilised WBAT Day 1 post-op
    • lying ↔ standing through side lying and perching is recommended
    • Educate re: injury & expectations, ADL’s, avoid heavy
    lifting,/jumping/sustained flexion for 6 weeks
    • MDT referrals
27
Q

What are complications of spinal fractures

A
  • Usual GA and spinal block risks
  • Blood clots
  • Infection
  • Chest pathology
  • Hardware failure/implant migration
  • Spinal Cord injury
  • Persistent pain
  • Transitional syndrome/adjacent segment pathology