Week 3: Spine & Pelvis Flashcards
Low back and neck pain:
What percentage of cases are non-specific?
What percentage of cases are specific pathology?
What percentage of cases are serious pathology?
- Non-specific (90%)
- Specific pathology (<10%) eg radicular pain, radiculopathy, spinal stenosis
- Serious pathology eg vertebral fracture, metastatic disease, spinal infection, axial spondyloarthritis or cauda equina
Define spondylosis
Progressive age related degenerative changes of the spine
Define sponylolysis
Stress fracture through the pars interarticularis of the lumbar vertebrae (usually L4-S1)
Define spondylolisthesis
A condition in which one vertebra has shifted forward in relation to the vertebra below it
Define Spondyloarthropathy
A family of inflammatory back disorders including ankylosing spondylitis
Neck pain grade I
Neck pain and associated disorders with no signs or symptoms suggestive of major structural pathology and no or minor interference with ADL’s
Neck pain grade II
No signs of symptoms of major structural pathology, but major interference with ADL’s
Neck pain grade III
No signs or symptoms of major structural pathology but presence of neurologic signs such as decreased deep tendon reflexes, weakness or sensory deficits in the upper extremity
Neck pain grade IV
Signs or symptoms of major structural pathology which include but isn’t limited to fracture, vertebral dislocation, injury to the spinal cord, infection, neoplasm, or systemic disease including inflammatory arthropathies
When is surgery indicated?
- Surgery should be reserved for when specific or serious cause of pain is present and even then it is not always indicated eg cancer, spondyloisthesis, traumatic fracture
- For many spinal complaints conservative management can and is sufficient to manage the problem
What are the two forms of decompression surgery?
Laminectomy (remove back part of vertebra)
Foraminotomy (remove bone around the foramen and relieve pinched nerve)
What is a discectomy?
Remove part/all of disk
What is a fusion?
Total disc replacement
What are the 3 phases of bone healing?
- Inflammatory phase (0-14 days)
- Reparative phase (Fibrocartilage callus formation –> days 0-21)
- Remodelling phase –> typically within 85-365 days
What population has excellent remodelling potential?
Children
In the reparative phase what are some important considerations? Name 2.
- Excessive motion at the fusion site can lead to excessive callus formation and delay of the reparative process.
- Don’t exceed mechanical limits of the newly formed tissue - overstressing tissue may result in tissue injury + delayed healing
What is a lumbar spine fusion?
Fixation of one vertebral body to another. Bone graft is taken from hip or pelvis and rods and screw are used.
With or without decompression (Laminectomy or foraminectomy)
Indications and considerations for lumbar spine fusion?
Indications:
- Severe pain
- Unstable fracture?
- Progressive spondylolisthesis
Considerations:
- Failed back surgery syndrome
- A lot of stress above/below fusion site
- Consider time for solid fusion (12-24 mths)
Post lumbar spine fusion: Days 1-5 –> 6 weeks - Precautions?
Avoid the following:
- Bending (flexing), Lifting (>5 kg), Twisting, (over) Extending.
- Prolonged sitting >30–60 min
- Limit pushing, pulling, bending
- Avoid driving
Post lumbar spine fusion what training and education should be provided to the patient initially (ie from day 1)?
- Must follow surgeons instructions
- Bed mobility training, log roll and STS
- ADL training with assistive devices
- Gait re-education
- Stabilisation exercises for breathing/relaxation of muscles
What is the stance on post-operative bracing following lumbar spine fusion?
- Often prescribed
- No additional benefit to quality of life and pain relief than no bracing (may be less effective) – Soliman et al (2018)
Post lumbar spine fusion Wks 6-10: walking tolerance, functional and light strength exercises?
What other areas should be targeted?
- Progress walking tolerance to 20-30 minutes
- Functional exercises
- Wall slides (to approximately 60 degrees of knee flexion)
- Side-lying hip rotation
- Standing rows/presses
- Initiate light strengthening exercises
- Abdominal breathing, hollowing, bracing
- Bracing during light functional movements
Also: balance, reinforce body mechanics, begin stretching hips/legs and shoulders
Post lumbar spine fusion Wks 11-19: walking tolerance & functional exercise?
- Progress walking tolerance to 30 to 60 minutes daily
- Increase aggressiveness of functional program slowly and to patient’s tolerance
- Supine marching
- Bridging
- Squats (to 90° of knee flexion)
- Prone over pillow or exercise ball
- Planks (half progressing to full) front and side (patient specific)
Post lumbar spine fusion Wks 11-19: other areas to target?
- Initial resistance training using weights (generally after 8-10/52)
- Continue cardiovascular training such as step ups, brisk walking, standing or flotation device – assisted pool exercises
