Chapter 43 Spinal

Question 1

Describe acute pain.

Answer 1

due to trauma or injury. Muscle strain or spasm, ligament sprain or disc degeneration/herniation - less than 3 months

Question 2

What is a herniated disc?

Answer 2

nerve pressure ( usually sciatic nerve- burning, stabbing, radiating pain)

Question 3

What is a spinal stenosis>

Answer 3

narrowing of the spinal cord or nerve root

Question 4

What is spondyloisthesis?

Answer 4

Defect in one of the vertebrae

Question 5

What is Spondylolisthesis

Answer 5

vertebrae slips onto the one below itself

Question 6

What is spondylosis?

Answer 6

degenerative changes in the spine

Question 7

How do you assess for lower back pain?

Answer 7

pain, mobility, paresthsia (tingling), urinary and bowel incontinence

Question 8

Describe interventions for acute lower back pain.

Answer 8

Position (Williams); Frequent position changes
Medications: NSAIDs acetaminophen, opioid/non opioid, analgesics, steroids
Epidural-corticosteroid/anesthetic

Question 9

Describe interventions for chronic lower back pain.

Answer 9

Antidepressants
Heat/cold application
PT
Weight restrictions

Question 10

What is phonophresis?

Answer 10

topical drug and 10 minutes of ultrasound (provided by PT)

Question 11

What is lontophoresis?

Answer 11

toical drug and electrical current (provided by PT)

Question 12

Describe surgical management for lower back pain

Answer 12

Minimally invasive
Patients will go home the same day
Conventional open- discectomy, laminectomy, fusion (p. 889)

Question 13

What are some post-op considerations for lower back pain?

Answer 13

Conventional surgery- first 24-48 hours are the most critical
VS (fever& hypotension may indicate bleeding and pain)
Neurologic assessment
Ability to void
Pain ( PCA/ Oral medication)
Drains/ drainage (clear drainage usually indicates meningeal tear. Patients with meningeal tear and CSF leak are placed in a supine position and strictly on bed rest. Notify physician immediately if you suspect a CSF leak.)
Moving/mobility
VTE prevention

Question 14

Explain failed back surgery syndrome (FBSS)

Answer 14

Usually due to the combination of organic, psychological and socioeconomic factors
Nerve blocks/ spinal cord stimulators
Repeated surgery
Intrathecal (spinal) injections with Ziconotide (Prialt)- N-type calcium channel blocker.

Question 15

Describe cervical neck pain.

Answer 15

Often due to bulging or herniated disc. (nerve compression)
Radiating pain
Contributing factors: aging, poor posture, lifting, tumors, rheumatoid arthritis, osteoarthritis, infection

Question 16

Describe nonsurgical pain management for cervical neck.

Answer 16

Position
Medication
PT

Question 17

Describe surgical management (anterior and posterior approach) for cervical neck pain management.

Answer 17

Postoperative management : airway, breathing, circulation
VS; bleeding/drainage; swallowing; I&O
Ability to void
Pain
Mobility

Question 18

What are some cervical neck pain surgical complications?

Answer 18

Hoarseness
Dysphagia
Esophageal, tracheal or vertebral artery injury
Wound infection
CSF leak
Hardware problems

Question 19

What is a complete spinal cord injury?

Answer 19

there is no innervation below the injury

Question 20

What is an incomplete spinal cord injury?

Answer 20

some function or movement belove thw injury is present

Question 21

List the primary injuries

Answer 21

hyperflexion
hyperextension
axial loading
rotation injuries
penetrating injuries

Question 22

What is hyperflexion mechanism of injury

Answer 22

extreme flexion of the neck; car accidents; injury to thorax and lumbar spine if due to fall on buttocks.-primary

Question 23

What is hyperextension mechanism of injury

Answer 23

rapture of longitudinal ligament- primary

Question 24

What is axial loading mechanism of injury?

Answer 24

vertical compression (vertebrae shatters) primary

Question 25

What are the secondary mechanisms of injury?

Answer 25

``` Hemorrhage Ischemia Hypovolemia Impaired tissue perfusion Local edema ```

Question 26

Describe an assessment for spinal cord injury.

Answer 26

History Airway; Breathing; Circulation (Cardiovascular and respiratory assessment) Airway may be compromised; C3-5 controls breathing; pulse, BP, bleeding Level of Consciousness (Glasgow coma scale) Spinal shock Sensory assessment GI & GU assessment

Question 27

What are some interventions for SCI?

Answer 27

``` Airway and breathing Intubation Coughing, pulmonary hygiene and suctioning Neurogenic shock Maintain hydration Monitor blood pressure (VS) Preventing secondary injuries Immobilization Body alignment Motor function & pain ```

Question 28

What are some interventions for SCI?

Answer 28

``` Pressure ulcers Frequent position change Surgery To stabilize the spine Urinary and bowel elimination Foley catheter Intermittent emptying Stool softeners Increased fluid intake ```

Question 29

What are some drug therapy for SCI?

Answer 29

``` Dextran- plasma expander Atropine sulfate – bradycardia tx Dopmine – hypertension Tizanidine- skeletal muscle relaxant Celebrex- heterotopic ossification Calcium & phosphate- prevent osteoporosis ```

Question 30

Autonomic Dysreflexia

Answer 30

know :) It is the idea that you could be sitting on a tac and a paralyzed patient may not recognize it but the body will and will respond by a shooting blood pressure. Caused by bladder, bowel, skin irritation

Question 31

What is a extramedullary spinal cord tumor?

Answer 31

within the spinal dura but not in the spinal cord

Question 32

What is the assessment for a spinal cord tumor?

Answer 32

Pain- Radicular Mobility –weakness, clumsiness, hyperactive reflexes Sensory perception Bladder and bowel weakness

Question 33

What is an intramedulliary spinal cord tumor?

Answer 33

within the spinal cord central gray matter

Question 34

What are some interventions for spinal cord tumors?

Answer 34

Surgery to relieve pressure and control symptoms Postoperatively: monitor VS, neurologic function, CSF leak Radiation- spinal cord can not tolerate high doses of radiation Overexposure manifestations even 6-12 mts post therapy Chemotherapy – limited options

Question 35

Describe multiple sclerosis.

Answer 35

Inflammation which causes demyelination and axonal injury Demyelination – slow or stopped impulses Characterized by periods of remission and exacerbation

Question 36

What are the 4 major types of MS?

Answer 36

Relapsing- Remitting type Primary Progressive Secondary Progressive Progressive Relasping

Question 37

What is relapsing remitting type of MS?

Answer 37

classic type. Symptoms develop and resolve with in few weeks or months

Question 38

What is primary progressive MS?

Answer 38

Progressive neurologic deterioration without remission

Question 39

What is a secondary progressive MS?

Answer 39

starts as relapsing/remitting but it gets progressively worst

Question 40

What is progressive relapsing MS?

Answer 40

frequent relapses with partial recovery

Question 41

What is the assessment for MS?

Answer 41

``` Presents as neurologic disease. Patients are often stiff and fatigued. Fatigue is very specific and disabling (sensitivity to temperature) Flexor spasm Hyporective reflexes Positive Babinski(toes curled outward) Unsteady gait Intention tremor (tremor with activity) Dysmetria Vertigo Speech problems ```

Question 42

What are some diagnostic tests for MS?

Answer 42

No specific test MRI CSF- increased protein & WBC CSF- IgG presence

Question 43

What are some interventions for MS?

Answer 43

``` Interventions: Mainly pharmacological (p 908) PT Promote mobility Psychotherapy ```

Question 44

Describe Amyotrophic Lateral Sclerosis- Lou Gehrig's Disease.

Answer 44

Adult onset Upper and lower motor neuron disease Progressive weakness and muscle wasting Leads to paralysis Affects the ability to talk, swallow, breathe Unknown cure Negative prognosis (death occurs with in 3 years of diagnosis) Unknown cause May be due to the combination of genetic, viral and environmental factors

Question 45

What is the assessment for Lou Gehrig's Disease?

Answer 45

Fatigue Muscle atrophy & Weakness Motor & Cognitive changes

Question 46

What are the interventions for Lou Gehrig's disease?

Answer 46

PT & OT Palliative Care Speech therapy Riluzole (Rilutek)