Week 3- Orthopaedic Management of the Spine (Elective & Trauma) Flashcards
(27 cards)
What are elective spine surgeries
- discectomy
- laminectomy/decompression
- fusion
- corrective surgeries eg scoliosis in children
What are traumatic spine surgeries
- fractures
- displacements/dislocations
What is a discectomy
- removal of part or complete herniated disc impacting on spinal nerves
- aka microdiscectomy
What are what are the indications for discectomy
Absolute:
-spinal cord compression: Caudia equinae
Relative:
- spinal nerve root compression: radiculopathy
- radiological imaging
- failure of non-operative treatments
What are additional procedures to a discectomy/ microdiscectomy
- Fusion
- artificial disc replacement
What are post op aims for a discectomy
- independent mobility, log roll
- good posture and spinal mechanics
- independent PDLs
- gradual sitting protocol as pain allows (check notes to see otherwise)
- limited lifting
What is a laminectomy
- also known as decompression
- removal of the laminate to enlarge the spinal canal to relieve pressure on the spinal cord or nerves
- lminotomy/foraminotomy: removal of a small portion of the laminate and ligaments, usually unilateral (decreases postoperative spinal instability)
- indications: spinal sternosis
What is the post op of a laminectomy?
• Check post op instructions • Commonly Protocol • Aims: -Independent mobility, log roll - Good posture and spinal mechanics – minimize lumbar flexion and extension - Independent PDLs - Limited lifting • 70 - 80% Patients positive outcomes
Describe a fusion including the indications
• Fuses 2 or more vertebral bodies together • Aim – restrict spinal motion and remove the source of mechanical back pain to relieve symptoms • Indication: - Trauma - Revisions - Tumour - Segmental degeneration - Deformity - Spondylolisthesis - Spondylolysis - Degenerative disc disease - Recurrent disc herniation
Post op of a fusion
• Check post op instructions • Commonly Protocol • Aims: - Independent mobility, log roll - Good posture and spinal mechanics – may have corset brace - Independent PDLs - Limited lifting
What are outcomes for a fusion
-varying
-dependent on patient selection
-higher success with:
• Motivated patients to return to work/function
• Patient without history of: Psychological issues and No litigation, workers compensation, or disability issues
What are the conditions where corrective surgeries are done?
- scoliosis: idiopathic, neuromuscular/ myelomeningocele
- lordosis/ kyphosis
- juvenile ankylosis spondylitis
What are indications for corrective surgeries
- fixed deformity
- stability of spine is compromised
- neurological deficit
What are the procedures for corrective surgeries
- osteotomy
- decompression
- fusion
- rods: magic grow rod, shilla procedures
- vertebral body stapling
- vertebral body tethering
When do you suspect a spinal injury?
Protection is priority, Detection is secondary
- Immobilise on rigid board- start spinal rules
- Apply rigid collar
- think about mechanism of injury —> fall/heavy load/bending/impact/RTA
- suspect in all unconscious patients —> they can’t tell you if they have any spinal pain
- presence of any neurological red flags
- any spine pain or tenderness —> however if no pain you can’t necessarily rule out injury
- don’t forget other injuries: beware the “distracting injury”
What is the Canadian C-Spine rule
- highly sensitive, reliable
- alert, stable, recent trauma: ? X-ray/CT
- not applicable in unstable patient, acute paralysis, known vertebral disease, prev CSp surgery, paediatrics, pregnant
Cervical fractures
• Usually the result of high energy trauma
• 80% 18-25yr old, Male to Female 4:1
• Suspected injury? Assume & immobilise until cleared
• May be associated with head injury
- Blunt head injury: suspect C1-3 involvement
• Needs neuro examination
• Paeds = C2/3, Adult = C5/6/7
• 5-10% unconscious MVA/Fall patients – CSp #
What is the management of a A0, minor, non-structural fracture
Soft collar
What is the management of A!, compression # single end plate
- soft collar/ spinal precautions: unconscious pts
- halo if pt not suitable for surgery
- surgery: anterior plating
What is the management of A2, coronal split/ pincer fracture
- soft collar/ spinal precautions: unconscious pts
- halo if pt not suitable for surgery
- surgery: anterior and posterior plating
What is the management of A3, burst fracture of single end plate
- soft collar/ spinal precautions: unconscious pts
- halo if pt not suitable for surgery
- surgery: anterior and posterior plating
What is the management of A4, burst fracture or sagittal split involving both endplates
- soft collar/ spinal precautions: unconscious pts
- halo if pt not suitable for surgery
- surgery: anterior and posterior plating
What are thoracolumbar fracture
• Usually the result of high energy trauma
- 40% MVA, 20% falls, 40% GSW/sport/occupational
• Pathological fractures
• Suspected injury? Assume & immobilise until cleared
• Mod-severe pain, worse with movement
• Needs neuro examination
• May have additional other injuries abdo
• Tx/Lx # + SCI involvement = 10-38% of #, 50-60% of #/Dislocation
What is the management of a thoracolumbar fracture
A0-minor, non-structural fractures
-brace: TLSO
A1 wedge/ compression #
-brace: TLSO
A2 coronal split/ pincer fracture
- brace: TLSO
- surgery: anterior and posterior plating with pins
A3 burst fracture of single end plate
- brace: TLSO
- surgery: anterior and posterior plating pedicle screws
A4 burst fracture or sagittal split involving both endplates
- brace: TLSO
- surgery: anterior and posterior plating with pedicle screws
B1 transosseous tension band disruption/ chance fractures
-surgery: posterior segment fixation with pedicle screws/ Schwann pins
B2 posterior tension band disruption
-surgery: anterior stabilisation (neural or disc damage) and posterior segment fixation with pedicle screws/ schnauzer pins
B3 Hyperextension
-surgery: anterior stabilisation (neural or disc damage) and posterior segment fixation with pedicle screws
C displacement or dislocation
-surgery: anterior stabilisation (neural or disc damage) and posterior segment fixation with pedicle screws
