Med bridge base and spinal

Question 1

What part of the healing process is consistent between tissues and patients?

Answer 1

Relative percentage of total healing time in each phase of healing
- 10% - acute
- 40% - repair
- 70% - remodeling
A longer acute phase means a longer repair phase and remodeling phase

Question 2

What is unique about the epithelial healing process

Answer 2

the coagulation phase - closing of the vessels is the first thing that needs to happen

Question 3

What consideration must be made with sheath tendons

Answer 3

More dependent on diffusion and has area of vascularity

Question 4

Bone healing has what to unique steps to its healing process

Answer 4

Soft callus phase - hematoma and clot transition to soft callus at 1-6 weeks, firborcartilage tissue and vascularization
hard callus has - transition to woven bone at 4-6 weeks
remodeling woven bones change to lamellar bone

Question 5

What is unique to healing process of nerves

Answer 5

• Wallerian degernation phase - immediate to 3 days - axon distal to the injury is removed during cellular stage and muscle activity is lost
• Axonal degerneation phase - day 4 to 1mm pre day of growth - schwann cells form a scaffold for the new axon to grow down to the end of the nerve

Question 6

what Seddon’s classificaiton the different types of nerve injuries

Answer 6

Seddon

• class I Neuropraxia - temporary interruption of nerve conduction
• class II axonotmesis - loss of nerve continuity with preservation of surround connective matrix, wallerian degeneration loss of nerve function peaking 3-4 days, restoration of nerve function 2-3 weeks post injury
• class III neurotmesis - disruption of the entire nerve structure requiring surgical innervation to repair

Question 7

What are sunderland’s classification of nerve injury

Answer 7

• class I - same as Seddon class I
• class II - same as Seddon class II
• class III - epineuryium and perineurium are intact, endoneuryium requires repair
• class IV - only the epineurium is intact
• class V - complete transection

Question 8

What MSK complication is associated with the antibiotic fluoroquinolone (cipro)

Answer 8

tedonopathy and tendon ruptures for up to 6 months post medication use

Question 9

What are the normal levels for RBC and hemoglobin

Answer 9

• RBC’s men 4.32-5.72 trillion, women 3.9 to 5.0 trillion

- hemoglobin ment 13.5-17.5 grams per deciliter, women 12.0-15.5 grams deciliter

Question 10

what is hematocrit and normal values

Answer 10

• test measures of the proportion of red blood cells in your blood
• men 39-51, women 34-46

Question 11

What is the value of the creatine kinase assay

Answer 11

• measure of the breakdown of creatine reach tissue (muscle, cardiac or skeletal)
• normal values men 171 and women 145
• greater than 2.5-3% heart damage
• less than 2.5-3% muscle damage
• significant muscle breakdown causes the number to sky rocket (rhabdo 50K-200K range)
• neuropathic weakness will have slight increases 500-3500 range)

Question 12

What are the normal levels for WBC and platelets

Answer 12

• WBC’s 3.5 to 12.5

- 140-400 K/uL

Question 13

What are normal blood gas tests

Answer 13

pH 7.35-7.45
PaCo2 35-45 mmHg
bicarbonate 22-26 mmol/L

Question 14

What pathologies would require a blood gas test (bag)

Answer 14

• heart failure
• kidney failure
• sleep disorder
• uncontrolled diabetes
• severe infections

Question 15

what is a blood uria estrogen test (BUN) ordered for

Answer 15

• 10-20 mg/dL
• low with rhabdomyolysis, low protein diet, over hydration
• high with dehydration, kidney disease

Question 16

How does immobilization impact muscles

Answer 16

• slow twitch (type I) are more affected
• well trained muscles less effected by immobilization
• single joint muscle more affected
• the shortened muscle with decrease while the length muscle with lengthen
• GAG loss on MTJ

Question 17

What is arthofibrosis

Answer 17

loss of gliding between collagen fibers and stiffening of the tissue due to loss of GAG and pH change

Question 18

Impact of immobilization on meniscus

Answer 18

• loss GAG and water causes reduction in meniscus full size

- delayed healing due to loss vascularization

Question 19

what is the ACDF procedure

Answer 19

anterior approached to cervical disc fusion

• complete disc removal and bone graph placement
• small plate is place to hold the joint still

Question 20

what structure are taken down with ACDF

Answer 20

• muscle SCM, platysmas, middle and anterior scalene, longus coli pulled off pain
• ligaments ALL, PLL and joint capsules

Question 21

Describe inflammatory healing after ACDF

Answer 21

• 0-2 weeks - cellular and blood loss prevention, pain and fatigue guide to rehab, collor 100%, avoid overhead lifting, avoid sleeping on your stomach

Question 22

describe reparative phase after ACDF

Answer 22

1-3 weeks - bone healing soft callus to hard callus, promote nerve mobility
- rehab unlikely during this stage, pain and fatigue guide to activity

Question 23

describe bone remodeling phase

Answer 23

• consolidation phase 4-9 weeks bone mineralization of callus (usually by day 64)
• maturation phase 19-52 weeks bone fully converted to lamellar bone and is able to start rehab at this point, tissues need to be remodeled
• x-ray will confirm healing

Question 24

what are the common complications associated with ACDF

Answer 24

• dysphagia
• hematoma
• laryngeal nerve palsy
• esophageal perforation

Question 25

What demographic variable have the greatest chance of ACDF success

Answer 25

- non smoking males, with low pain, better ROM and low NDI scores - surgery within 6 months of injury

Question 26

Indications for microdiscetomy

Answer 26

``` relative - disc herniation - failed conservative treatment - recurrent radicular symptoms - neuro deficits absolute - progressive neuro deficits - cauda equina syndrome ```

Question 27

describe the microdiscetomy procedure

Answer 27

- soft tissues retracted - access hole created the lamina and/or ligamentum flavuum - nerves are retracted and the offending portion of the disc is removed

Question 28

what is the rehab objective of the inflammatory phase of microdiscectomy

Answer 28

weeks 1-3 - promote healing - control pain - promote dural mobility - avoid prolong flexed position in sitting and sleeping - no driving for 2 weeks - avoid slump testing, hip strength testing and hip hing lifting

Question 29

describe the reparative phase post microdisctomy

Answer 29

- starts week 4-6 - cochrane review found high intensity exercise better than low intensity - avoid loaded lumbar flexion because healing is not fully complete

Question 30

How long should you avoid running after microdiscectomy

Answer 30

12 weeks post op

Question 31

what the indications for progressing to the remodeling phase of rehab following microdiscetomy

Answer 31

- pain control is performed with changing position or light stretching - performing all ADL's - can start end range motion assessment

Question 32

what complications are associated with microdiscectomy

Answer 32

most common - reoperation - dural injury - recurrent disc complication - nerve root damage - wound complications - new or worsening neuro deficits - hematoma

Question 33

What is the prognosis for microdiscectomy

Answer 33

- delay longer than 6 months is associated with worse outcomes - success rate up to 90-95% in eliminating radicular symptoms and back pain - scores measuring quality of life, depression, disability and pain are know to improve

Question 34

Describe the posterior lumbar fusion procedure

Answer 34

- lamina is removed - disc is debrided leaving the out edge of the annulus to hold the bone graph - pedical screws are inserted and covered with bone graph

Question 35

how long is the inflammatory phase of fusion

Answer 35

up to 6 weeks | - restricted driving and flexion based moments

Question 36

what is the time frame for the reparative phase of fusion

Answer 36

6-10 weeks | - avoid loading lumbar spine during this phase and lifting greater than about 10 pounds

Question 37

what are some associated complications with spinal fusion

Answer 37

- intraoperative neurologic injury - implant migration - dural tears - infection - heterotophic ossification - osteolysis - loss of bone tissue - chronic pain - adjacent segmental instability

Question 38

what is the prognosis for fusion

Answer 38

- high patient satisfaction and outcome scores - decreased pain - increased ODI scores - post surgical motor loss was the greatest predictor of negative patient outcomes

Question 39

Describe the findings of the 2009 cochrane review of rehab after lumbar disc surgery

Answer 39

- examined exercising starting 4-6 weeks post op - low evidence for short term gains exercise being more effective than no exercise - moderate evidence for exercise improving functional compared to exercise - low evidence for high intensity exercise over low intensity exercise - moderate evidence for high intensity providing better functional outcomes - low evidence for HEP works as well has formal rehab - no evidence for increased reoccurrence of back pain with exercise program after the first surgery

Question 40

what did the Chien 2016 study on ACDF 1 versus 2 level find regarding cervical kinematics

Answer 40

- 2 level fusion had significant impact on ROM and upper segmental compensatory changes (lower did not appear affected)