Surgical Procedures for the Spine Flashcards
(53 cards)
Cervical spine surgeries are for pt’s who:
- for patients with persistent radicular pain who do not respond to conservative measures
- significant extremity or myotome weakness
- progressive neuro deficits (worsening over time)
- severe pain (no position of comfort)
- pain that lasts beyond a conservative intervention period of 8-12 weeks
Anterior Cervical Disectomy and Fusion: purpose of surgery
to remove disc herniations and or to relieve spinal cord and nerve root pressure
Anterior Cervical Disectomy and Fusion removes which types of herniations?
lateral and central
95% chance of good/excellent relief from radiating arm pain
numbness usually improves
resum full, unrestricted activity wihtin 3-6 months
Rare complications of Anterior Cervical Disectomy and Fusion
sore throat, hoarseness, difficulty swallowing, failure of bony fusion (bone doesn’t heal), pseudoarthrosis (non-union)
Advantages of Anterior Cervical Fusion
provides stability to motion segment
immoblize painful degenerative disc and facets
disadvantage of anterior cervical fusion
progression of degenerative changes at other levels – degeneration of other segments can occur b/c fused segment not moving so now other segments have to move more
Anterior Corpectomy and Fusion
removal of the vertebral body and disc spaces at either end. goal is to decompress cervical canal
Anterior Corpectomy and Fusion performed when?
performed when cervical disease encompasses more than just disc space
- multi level cervical stenosis or spinal cord compression cause by bone spurs
Anterior Corpectomy and Fusion post op
post op rigid cervical orthosis often used
Laminectomy (cervical) is used to treat what
used to treat spinal stenosis
Laminectomy (cervical)
resect lamina on one or both ends
increases axial space for SC
usually done when more than one level is involved
goals of cervical laminectomy
progression of SC damage should stop
fxnl return for walking and use of hands - if nerve damage wasn’t too bad and hasn’t already become permanent before surgery done
complcations of cervical laminectomy
instability due to removing multiple segments
post-laminectomy kyphosis (requires surgical revision)
myofascial pain
occipital headaches
Laminoplasty for who?
indicated for multi-segmental spondylotic myelopathy
superior functional recovery compared to laminectomy for spondylotic myelopathy
what is spondylotic myelopathy
compression of the spinal cord
laminoplasty
one side of lamina is cut and other side is scored so that canal can be widened. bone is then added to keep canal widened. room for Sc when issue is multi-level
complcations of laminoplasty
nerve root injury occurs from surgery in 11% of cases
potentially caused by the cord moving posteriorly after surgery, causing traction and damage to the nerve root
Post Surgical PT for cervical spinal surgery
no set guidelines for specific surgeries
protocols vary - listen to surgeon, consider bone healing time! especially in fusion pt’s - bone takes a long time to heal; may not see pt’s for a few months post op
Post op brace
used after discetomy and corpectomy
brace for first few weeks or months
padded plastic neck brace or cervicothoracic brace (CTO)
reduces pain and stress on neck
improves bone healing by maintaining neck in rigid position
General pt goals initally after surgery
reduce pain and inflammation prevent post op complications protect surgical site prevent recurrent herniation maintain dural mobility improve fxn minimze effects of immoblization
early return to function post op (cervical surgery) instruct pt in what?
bed mobility, gait, transvers, wound care
early return to function post op (cervical surgery) 1 week
patients are allowed to shower
early return to function post op (cervical surgery) 7-10 days
safe return to sedentary occupational duties but avoid prolonged positions
Out patient PT: begin 2-3 weeks depending on pt and procedure: EXamination
history, inspect wound site, postural exam, neuro exam including neurodynamic and strength testing -myotomes!
