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Spine Flashcards

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1
Q

What are the influences of gravity on postural alignment?

A

Places stress on structures responsible for maintaining the body upright
Due to body’s anterior/posterior sway, muscles are necessary to control sway and maintain equilibrium

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2
Q

Where is the gravity line for the ankle?

A

Gravity line is anterior to the joint and tends to rotate the tibia forward, stability is provided by plantarflexor muscles

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3
Q

Where is the gravity line for the knee?

A

Gravity line is anterior to the knee joint (keeps knee in extension)

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4
Q

Where is the gravity line for the hip?

A

Gravity line varies with body’s sway, when the line passes through the hip joint, there is equilibrium

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5
Q

Where is the gravity line for the trunk?

A

Gravity line passes through the bodies of the lumbar and cervical vertebrae

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6
Q

Where is the gravity line for the head?

A

Gravity line falls anterior to the atlanto-occipital joints

Posterior cervical muscles contract to keep the head balanced

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7
Q

What are the common causes of lordotic posture?

A

sustained faulty posture
pregnancy
obesity
weak abdominal muscles

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8
Q

What are the potential muscle impairments of lordotic posture?

A

impairment in hip flexor muscles

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9
Q

What are the potential source of symptoms in lordotic posture?

A

stress to anterior longitudinal ligament, narrowing of posterior disk space, approximation of the articular facets

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10
Q

What are common causes of relaxed/slouched/swayback posture?

A
  • muscles are not used to provide support

- passive structures provide stability

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11
Q

What are potential muscle impairments of relaxed/slouched/swayback posture?

A
  • mobility impairment in the upper abdominal muscles
  • impaired muscle performance due to stretched and weak lower abdominal muscles
  • extensor muscles of the lower throacic region
  • hip flexor muscles
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12
Q

What are the potential source of symptoms of relaxed/slouched/swayback posture?

A
  • stress to iliofemoral ligaments
  • anterior longitudinal ligament of the lower lumbar spine
  • posterior longitudinal ligament of the upper lumbar and thoracic spine
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13
Q

What are the common causes of flat low-back posture?

A
  • continued slouching or flexing in sitting or standing postures
  • too much emphasis on flexion exercises
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14
Q

What are the characteristics of flat low-back posture?

A
  • characterized by a decreased lumboscaral angle
  • decreased lumbar lordosis
  • hip extension
  • posterior tilting of the pelvis
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15
Q

What are the potential muscle impairments of flat low-back posture?

A
  • mobility impairment in trunk flexor muscles an hip extensor muscles
  • impaired muscle performance due to stretched ad weak lumbar extensor and possible hip flexor muscles
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16
Q

What are the potential source of symptoms of flat low-back posture?

A
  • lack or normal lordotic curce
  • stress to posterior longitudinal ligament
  • increased posterior disk space
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17
Q

What is the position of the pelvis in lordosis posture?

A

-anteriorly tilited

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18
Q

What is the position of the pelvis in kyphosis/lordosis?

A

-anteriorly tilted

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19
Q

What is the position of the pelvis in sway back posture?

A

-posteriorly tilted

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20
Q

Common faulty postures:

A
  • round back with forward head
  • flat upper back and neck posture
  • scoliosis
  • structural scoliosis
  • non-structural scoliosis
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21
Q

Acute inflammatory stage:

A

less than 4 weeks

  • constant pain
  • signs of inflammation
  • pain is not completely relieved by position or movement
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22
Q

Acute stage without signs of inflammation:

A
  • symptoms are intermittent
  • related to mechanical deformation
  • signs of irritability when nerve root or spinal nerve is compressed or placed under tension
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23
Q

Subacute stage

A

(4 to 12 weeks)

-certain movements and postures provoke symptoms, including some IADLS

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24
Q

Chronic stage

A

(more than 12 weeks)

-emphasis is placed on returning the patient to high-level activities

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25
Acute Spinal Problems/Protection Phase
Patient education Symptoms relief or comfort Kinesthetic awareness of safe postures and effects of movement Core muscle activation and basic stabilization Basic functional movements
26
Subacute Spinal Problems/Controlled Motion Phase
``` Pain management Kinesthetic training Stretching/mobilization Muscle performance Cardiopulmonary conditioning Postural stress management and relaxation exercises Functional activities ```
27
Chronic Spinal Problems/Return to Function Phase
``` Emphasize spinal control during high intensity and repetitive activities Increased mobility Improved muscle performance Increased cardiopulmonary endurance Patient education ```
28
What constitues patient education in chronic spinal problems?
Posture correction Safe-progression to high-level or high-intensity activities Self-maintenance and healthy exercise habits
29
What exercises of skills that all patients with spinal impairments should learn:
Kinesthetic training Stabilization training Functional training
30
Kinesthetic training:
Awareness and control of safe spinal motion Awareness of neutral spinal position Awareness of effects of ADLs and extremity motion on the spine
31
Stabilization training:
Core muscle activation and sustained contraction | Global muscle control of spinal posture with extremity loading
32
Functional training
Log roll supine to prone, prone to supine Supine to side-lying to sitting and return Sit to stand and return Walking
33
Patient education:
Patient participates in identifying desired outcomes Education regarding stages of healing Limit passive treatment, patient needs to be engaged in the process Instruction in self-management Instruction in prevention of future injury or reinjury
34
Indications for spine surgery:
Relief of pain related symptoms with disc disease Management of fractures Management of hypermobile spinal segments Management of deformities Removal of tumors
35
Anterior surgical approach for ACDF:
C3-C7 for cervical approach | thyroid, trachea, esophagus
36
Anterior retroperitoneal approach:
lumbar spine
37
Posterior approach
lumbar spine
38
Indications for surgery for discectomy and microdiscetomy
Upper or lower extremity radiculopathy due to nerve root irritation that have failed conservative measures
39
Removal of disc fragments and herniated disc material
-compressing the adjacent nerve root
40
Microdiscectomy:
Procedure purpose is the same as discectomy | Performed through a smaller incision under greater magnification
41
Laminectomy:
May accompany discectomy | Spinal lamina is removed for greater exposure of a nerve root; ligamentum flavum also removed
42
Corpectomy:
removal of part of vertebral body
43
Disadvantage of laminectomy:
exposure of spinal cord
44
When is fusion indicated?
Pt. presents with axial pain combined with instability, arthritic changes, or uncontrolled peripheral pain
45
Types of fusion
ACDF TLIF Platysma and longus coli muscles are interrupted
46
Vertebroplasty
Injectable substance (Polymethylmethacrylate) permeates cancellous bone Stabilization ‘Internal casting’
47
Kyphoplasty
Balloon insertion | Injection of PMMA
48
What is a drawback of vertebroplasty?
Lack of height restoration and deformity restoration
49
What are compression fracture treatment?
kyphoplasty and vertebroplasty
50
Scoliosis Correction
Installation of hardware to correct spinal deformity | Performed when Cobb angle is > 40 degrees
51
Complications with C-spine surgeries:
Paralysis Recurrent laryngeal nerve impairment Speaking volume diminished Hoarseness
52
Complications with all spine surgeries
``` Paralysis Infection Dural tear with CSF leak Non-union Radiating pain General surgical complications: DVT, pneumonia ```
53
What is important to emphasize after surgery?
``` Early mobility Precautions Bending, twisting, lifting Body Mechanics education Bracing Transfers: Log Rolling Walking program Incision inspection ```
54
Incision Inspection:
``` rubor (redness) Calor (heat) dolor (pain) tumor (swelling) functio laesa (loss of function) ```
55
Maximum Protective Phase:
- patient education - would management & pain control (inspection) - bed mobility - bracing - exercises - contraindications
56
Bracing:
Philadelphia collar for ACDF | TLSO or LSO for TLIF
57
What exercises are avoided in maximum protective phase?
- extension for patient's having undergone laminectomy - twisting - encourage internal bracing of abdomen - lifting within appropriate limits
58
Moderate and Minimum Protective Phases:
- scar tissue mobilization - progressive stretching and joint mobilization - muscle performance - gait training - contraindications
59
What stretching and joint mobilizations are done in the moderate and protective phases?
Gentle (Grade 1 and 2) joint techniques at adjacent segments to surgical site Pain modulation ROM
60
What muscle performance is done in the moderate and protective phases?
Segmental to global stabilization Patient goals for activity return Single plane to multi-planar movements
61
What gait training is done in the moderate and protective phases?
Postural neutrality
62
What are the contraindication in the moderate and minimum phases?
Mobilizations on the level(s) of the fusion | Extension exercises for patients having undergone a laminectomy

Acute (16 decks)

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