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Semester 3 PM Exam 2 > Spinal Surgeries > Flashcards

Spinal Surgeries Flashcards

(62 cards)

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1
Q

Surgical Intervention of the Cervical Spine reserved for

A

patients with persistent radicular pain who do not respond to conservative measures

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2
Q

Surgical intervention of the cervical spine also for those with

A

Significant extremity or myotomal weakness
Progressive neuro deficits
Severe unremitting pain
Pain the persists beyond a conservative intervention period of 8-12 weeks

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3
Q

Common surgical procedures for cervical disc injuries

A

Ant cervical discectomy and fusion
Ant corpectomy and fusion
Laminectomy and laminotomy-facetectomy
Laminectomy or laminoplasty (with or without fusion)

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4
Q

Laminoplasty

A

One side of the lamina partially scored, the other side cut through, open like a hinge, then add bone graft on opp side to make canal larger

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5
Q

Laminotomy

A

Removes part of the lamina

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6
Q

Anterior cervical discectomy and fusion purpose

A

to remove disc herniations

to relieve spinal cord or nerve root pressure

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7
Q

Ant cervical discectomy and fusion used for what pathologies

A

Lateral and central herniations are removed this way

95% chance of good to excellent relief from radiating arm pain - numbness usually improves too

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8
Q

Ant cervical discectomy and fusion - outcome

A

resume full, unrestricted activity activity 3-6 months

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9
Q

Ant cervical discectomy and fusion - complications Rare

A 
Sore throat
Hoarseness
Difficulty swallowing
Failure of bony fusion 
Pseudoarthrosis (non-union)
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10
Q

Ant cervical discectomy and fusion - advantages to fusion

A

Provides stability to the motion segment

Immobilize painful degenerative disc and facets

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11
Q

Ant cervical discectomy and fusion - disadvantages to fusion

A

Progression of degenerative changes at other levels

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12
Q

Anterior Corpectomy and Fusion is what

A

Removal of the vertebral body as well as the disc spaces at either end, to completely decompress the cervical canal

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13
Q

Ant corpectomy and fusion is performed when

A

cervical disease encompasses more than just the disc space
multi level cervical stenosis
or spinal cord compression caused by growth of bone spur

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14
Q

Ant corpectomy and fusion - post op

A

Rigid cervical orthosis often used

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15
Q

Laminectomy often used to treat

A

Spinal stenosis
Resect lamina on one or both sides
Inc axial space available for spinal cord
Usually done when more than one level involved

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16
Q

Goals of laminectomy

A

Progression of spinal cord damage should stop

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17
Q

Outcome with laminectomy

A

Functional return for walking and use of hands - if the nerve damage was not too severe and has not become permanent

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18
Q

Complications with laminectomy

A

Instability
Post-laminectomy kyphosis (requires surgical revision)
Myofascial pain
Occipital headaches

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19
Q

Laminoplasty indicated for

A

multi-level spondylotic myelopathy
Superior functional recovery compared to laminectomy for spondylotic myelopathy (people do better with this for cord compression as opposed to a laminectomy)

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20
Q

Complication with laminoplasty

A

Nerve root injury can occur in 11% cases

Potentially caused by traction on enrve roots with post migration of the cord

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21
Q

Post-surgical PT

A

no set guidelines
Important to have communication with the surgeon - protocols vary based on surgery, surgeon, patient - need to consider bone healing time if fusion

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22
Q

Post-operative brace

A

Used following some surgeries
Brace first few weeks or months
Padded, plastic neck brace or cervicothoracic brace
Reduces the pain and stress on the neck
Improves bone healing by maintaining the neck in right position

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23
Q

Goals: Initial period following surgery

A 
Reduce pain and inflammation 
Prevent postsurgical complications
Protect the surgical site 
Prevent recurrent herniations
Maintain dural mobility
Improve function
Minimize detrimental effects of immobilization
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24
Q

Early return to function - instruct in

A

Bed mobility
Gait
Transfers
Wound Care

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25
Early return to function - 1 week:
Patients are usually permitted to shower
26
Early return to function - 7 to 10 days
Safe return to sedentary occupational duties/avoid prolonged positions
27
Early return to function - Encourage
short walks several times a day
28
Out patient PT - begins
week 2 or 3 if appropriate | depending on procedure done and individual patient
29
Out patient PT - Examination
Thorough history Inspect wound site Postural exam Neural exam including neurodynamic and strength testing
30
Out patient PT - Intervention
``` Education posture/body Mechanics Gentle ROM Submax isometrics Arm and led exercises (avoid heavy lifting 4-6 weeks) Electrotherapeutic modalities Physical agents Scar massage ```
31
Out patient PT - intervention - week 4 post op
progressive strengthening exercises for spinal stabilizers
32
Out patient PT - intervention - cardiovascular conditioning exercises
Stationary bicycle; UBE; stair stepper, swimming | Start brief 5-10min, gradually inc to 30-60min
33
Out patient PT - intervention - 6 to 8 weeks
jogging permitted if minimal pain | Morning activities are best (disc maximally hydrated)
34
Out patient PT intervention - 12 weeks
Higher impact sports like basketball or soccer usually permitted
35
Surgeries for lumbar radiculopathy
1. Diskectomy - hemilaminectomy and diskectomy - percutaneous diskectomy - microdiskectomy 2. Laminectomy 3. Decompression 4. Fusion
36
Aims of lumbar surgery for radiculopathy
1. Relieve pain | 2. Restore neural function
37
Diskectomy - Hemilaminectomy and Diskectomy
Posterior approach | To treat herniated lumbar IVD
38
Diskectomy - Hemilaminectomy and Diskectomy - Aims
Decompress involved nerve root Minimize scar formation Avoid latrogenic nerve damage
39
Diskectomy - Percutaneous Diskectomy
Minimally invasive Uses probe for aspiration of the NP material from the IVD For those w/o stenosis, severe arthritis, hypertrophy
40
Microdiscectomy - what is it
Removal of disc materal causing compression or irritation of a nerve root Ligamentum flavum and part of facet is removed
41
Microdiscectomy - success rate
Greater than 90% success rate | Patients are usually able to return to previous activity level/sports
42
Laminectomy
removal of the lamina | invovles removal of SP and ligamentum flavum caudal and cranial to the lamina
43
Laminectomy - disadvantage
Destabilizing effect on the segment
44
Decompression
Laminectomy with partial facetectomy | May include laminoplasty or unilateral laminotomy for canal enlargement
45
Fusion
Lack of consensus on indications - spinal stenosis - Degenerative disc disease with no herniation or stenosis
46
Fusion compared to laminectomy without a fusion
Wider surgical exposure/more extensice dissection | Longer operation time
47
Fusion - advantages for recurrent disc herniations
Reduce/eliminate segmental motion Reduce stress on degenerated disk space Reduce incidence of additional herniation at the affected disc space
48
Fusion - Bone grafts
Autologous or allograft or bone matrix product
49
Fusion - Interbody cages
Anterior lumbar interbody fusion (ALIF) Posterior lumbar interbody fusion (PLIF) Plates Pedicle Screws
50
Post-surgical PT - lumbar
No set guidelines again | Communicate with surgeon
51
Goals - initial period following surgery - lumbar
``` Reduce pain and inflammation Prevent postsurgical complications Protect the surgical site Prevent recurrent herniation Maintain dural mobility Improve function Minimize detrimental effects of immobilization ```
52
Early return to function - instruct in (lumbar)
``` Bed mobility Gait Transfers Wound care Body mechanics ```
53
Early return to function - lumbar - 1 week
Patients are usually permitted to shower
54
Early return to function - instruct in (lumbar) - 7 to 10 days
Safe return to sedentary occupational duties/avoid prolonged positions
55
Early return to function (lumbar) - driving? encourage...
No driving for 2 weeks | Encourage short walks several times per day
56
Out patient PT - lumbar - begin
week 2 or 3 if appropriate | Depending on procedure done and individual patient
57
Out patient PT - lumbar - Examination
Thorough history Inspect wound site Postural exam Neural exam including neurodynamic and strength testing
58
Out patient PT - lumbar - intervention
``` Education posture/body mechanics Gentle ROM Submaximal isometrics Arm and leg exercises (4 to 6 weeks) Electrotherapeutic modalities Physical agents Scar massage ```
59
Out patient PT - lumbar intervention - week 4 post op
progressive strengthening exercises for spinal stabilizers
60
Out patient PT - lumbar intervention - Cardiovascular conditioning exercises
Stationary bike, UBE, stair stepper, swimming, start brief 5-10 min, gradually inc to 30-60 min
61
Out patient PT - lumbar intervention - 12 weeks
Higher impact sports like basketball or soccer usually permitted; work hardening
62
Complications following surgery - lumbar
``` Not specific to spinal surgeries Post surgical infection Poor wound healing Scars and adhesions Venous thromboembolism Pulmonary embolus Weakness or muscle atrophy Psychosocial problems/yellow flags/fear avoidance ```

Semester 3 PM Exam 2 (4 decks)

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