Lecture 3 Flashcards
What is a Rhizotomy?
Frying the nerves
KNOW: Radiofrequency abilation = rhizotomy
KNOW: These don’t work well, killing a nerve sucks
KNOW: With a rhizotomy relief is temporary - may cause worsening pain in the long term
They use an electrode to zap the nerve
What is a selective nerve root block?
Is it perminant?
They go in, go to nerve and give it an injection to numb it completely
Temporary
NOTE: Can last several years, but the more you get them the more you need them
What is the purpose of a laminectomy?
What diseases are it used for? (5)
What is removed?
Used to increase space. Takes pressure off the spinal cord.
Used in advanced cases of degenerative disc disease / stenosis (which both put excessive pressure on SC). Advanced stages of osteoarthritis (crushing down), osteophyte growth (causing stenosis), pts w/ RA (if its attacking itself bone will grow on bone because of wolfs law)
Laminae, and spinous process are removed (recaged to protect)
What does -tomy mean?
act of cutting
What is a laminotomy?
Removal of a small part of laminea to allow for more room for the SC in that area (prefurred route)
Whats the difference between between laminectomy vs laminotomy
Laminectomy = SP removed, not in the other
What imaging technique would give us the best vision of encroachment of the SC because of bone (intrusion of the SC due to bone)
What view would be the best?
CT scan lets us see that bone the best
Axial (essentially transverse)
When would someone get a foraminotomy over a laminotomy?
If they have forminal stenosis (intervertebral foramen). Essentially the spainl nerve is being compressed and were trying to alleviate that.
If its a more central compression they would to the lamina ones
What is always given to pts after c-spine surgery
soft collar
Should you let c-spine pts sit still after surgery?
No
Is it easier to fuse cervical spine from anterior or posterior?
Anterior - not much muscle on anterior neck / no SP to get in the way
What is the surgery done in the picture below?
Anterior cervical disectomy and fusion (fusing of cervical spine and taking disc out and placing a spacer in)
Should we mobilize someones neck (and do ROM) with an anterior cervical disectomy and fusion?
Yes! the surgen moves their neck around like crazy to make sure it won’t be an issue when we do it.
KNOW: They can add disc replacements that can still move in the x,y,z plane
Whats the biggest issue with these?
They arent as stable. pt might feel clunk from time to time (most likely didnt actually dislocate)
The last thing we want to do is fuse the neck. What do surgery do we do instead of neck fusion?
Disc replacement to allow for full mobility still (flex,extension,rotation, etc…)
