Lecture 3 Flashcards
pre-op mgmt
- pain
- ROM (keep it full b/c pre-op ROM will influence post-op ROM)
- educate pt on expectations (swelling, pain, timeline)
- precautions
- AD as needed
watch out for these things post op (early and late phases of healing)
local/systemic infection
DVT or PE
delayed healing of wound or bone
mm deficits
nerve entrapped
adhesioin/scarring
“immediately after a soft tissue injury, do not harm and let ____ guide your approach”
“after the first days have passed, soft tissues need ____”
PEACE
LOVE
PEACE stands for
Protection
Elevation
Avoid anti-inflammatories
Compression
Education
LOVE stands for
Load
Optimism
Vascularization
Exercise
tissue healing timeline
slide 6
MAX protection phase
time frame? things to consider?
right after surgery (days to 6 wks)
be aware of WB status and light loading
tissue inflammation and pain in this phase
MOD phase of healing
time frame? things to work on?
less infalmmation, more mobility
4-12 weeks
return to AROM pain free
- restore normal arthorkinematics
- gradually increase strength
**- imporve NMSK control and stability **
MIN protection phase
time frame? things to consider?
6 weeks to 12 months
- restore strength
- consider sport / activity training
- be specific w/ patient education
progression of post-op phases depends on ability to meet ____.
GOALS
(i.e. can’t strengthen if pt is still swollen)
what are indications for surgery?
cauda equina
acute loss of function (rapid foot drop)
failure of 3 months conservative care (PT, Injections)
post of precautions
no BLT (bending, lifting, twisting)
log roll
sitting into car
extension instantaneous axis of rotaiton : aging of the lumbar spine
decreased segmental control from the ____
increaased stress on the ____ and ____
disc
facet / disc
SB instantaneous axis of rotaiton : aging of the lumbar spine
increased ____ and increased ____ chondral load
shearing
facet
surgical options
laminectomy
decompression without fusion (microdiscectomy)
posterior lumbar interbody fusion (PLIF)
Transforaminal lumbar interbody fusion (TLIF)
Anterior lumbar interbody fusion (ALIF)
long term post op
adjacent segment degeneration
(becomes symptomatic causing pain or numbness)
biomechanical effects of surgery:
alters biomechanics of both involved and adjacent segments center of rotaiton
this leads to increased forces and compression on the ____
intervertebral disc
decompression with motion preservation (disc replacement) is contraincated when
hypertrophic facets
translational deformity (spondy)
Ankylosing spondylitis
poor bone quality
post surgical mgmg stages of recovery
- disc hydration/dehydration
- change positions every 15-30 min
- avoid stretching and rotation of lumbar s
- avoid prone/flat sleeping
- think about healing times
sacral nutation associated with what type of innominate movement
posterior innominate
SIJ counternutation is associated with
innominate anterior rotation
sacral nutation increases ____ spine
extension
sacral counternutation increases ____ spine
flexion
this ligament is a big pain generator in LBP… an issue when lumbar spine flexes and sacrum doesn’t move
posterior SI ligament
