Surgical Considerations: Cervical and Lumbar Spine

Question 1

Medical Clinical Indications for surgery: Cervical

Answer 1

• Fracture: in the Upper cervical or posterior 1/3rd of cervical vertebrae
• Cervical Myelopathy
• Advances Spondylitic Changes (Malalignment of vertebral bodies and neuro findings, encroachment on central cord)
• Cervical Radiculopathy with:
  – Progressive neurological findings
  – Not responding to Tx (followed by oral predisone followed by epidural injection, prior to consideration of surgery)

Posterior 1/3rd: Lamina and spinous process

Question 2

Medical Clinical Indications for surgery: Lumbar

Answer 2

• Lumbar Fracture: posterior 1/3rd of lumbar vertebrae
• Cauda Equina
• Signs of infeciton
• Advanced spondylolisthesis: with neuro findings
• Advanced spinal stenosis due to degenerative changes with neuro findings
• Lumbar radiculopathy with:
  – Progressive neurological findings (reduction of reflexes, increase sensory deficits, progressive myotomal weakness) and symptoms correlate with MRI imaging)
  – Not responding to conservative rehabilitation and oral predisone and epidural injection

Question 3

Cervical or lumbar surgery is NOT INDICATED with any of the following:

Answer 3

• CHRONIC, PERSISTANT PAIN
• Central Sensitization (Nociplastic) pain
• Degenerative changes on plain films WITHOUT radiating pain (normal with aging)
• Pain with associated elevated levels of fear, altered beliefs, in litigation forpersonal injury or work injury.

Question 4

PT Considerations Post Op: Hardware vs No Hardware

Answer 4

Hardware:
* No PT until 6 weeks
* Adhere to the protocol from Surgeon
* Do NOT perform joint mobilizations
* Light to moderate ST mobilizations
* Motor Control, Active ROM and strengthening
* Neurodynamics as needed

No Hardware
* No motion limitations
* Gentle I or II level Joint Mobs; Avoid pressure over spinous process; NO thrust mobilizations
* Motor Control, Strengthening and Active ROM
* Neurodynamic mobilizations as needed
* ST mobilization after incison heals