Podcast
Questions and Answers
What is the primary focus of the information presented?
What is the primary focus of the information presented?
- Detailing surgical techniques for lumbar spine procedures.
- Discussing the pharmacological management of post-operative pain following lumbar surgery.
- Providing an overview of common lumbar spine procedures and rehabilitation considerations. (correct)
- Comparing the efficacy of different surgical approaches to lumbar fusion.
A physical therapist is designing a rehabilitation program for a patient who underwent a lumbar spine procedure. Which of the following considerations is MOST critical during the initial phase?
A physical therapist is designing a rehabilitation program for a patient who underwent a lumbar spine procedure. Which of the following considerations is MOST critical during the initial phase?
- Aggressive strengthening of the core musculature to prevent future instability.
- Early introduction of high-impact activities to promote bone healing.
- Ignoring pain reports to encourage faster return to function.
- Protecting the surgical site and ensuring proper wound healing. (correct)
A patient is 3 weeks post-op lumbar fusion. They are complaining of increased pain and radiating numbness into their leg. What is the MOST appropriate initial action?
A patient is 3 weeks post-op lumbar fusion. They are complaining of increased pain and radiating numbness into their leg. What is the MOST appropriate initial action?
- Contact the surgeon to rule out potential complications or hardware issues. (correct)
- Immediately progress them to more challenging exercises to desensitize the nerve.
- Prescribe a course of oral corticosteroids to reduce inflammation
- Instruct the patient to continue with their home exercise program and monitor symptoms.
When designing a rehabilitation plan following a lumbar laminectomy, which factor is MOST important to consider regarding the patient's return to activities?
When designing a rehabilitation plan following a lumbar laminectomy, which factor is MOST important to consider regarding the patient's return to activities?
A patient who underwent a microdiscectomy reports feeling good and wants to return to heavy lifting at 2 weeks post-op. What advice should be given?
A patient who underwent a microdiscectomy reports feeling good and wants to return to heavy lifting at 2 weeks post-op. What advice should be given?
A patient reports leg pain and neurological deficits. Which lumbar spine procedure is MOST effective at addressing these specific symptoms?
A patient reports leg pain and neurological deficits. Which lumbar spine procedure is MOST effective at addressing these specific symptoms?
Following a facet joint injection, which rehabilitation approach is the MOST appropriate initial focus, considering the procedure's target?
Following a facet joint injection, which rehabilitation approach is the MOST appropriate initial focus, considering the procedure's target?
A patient is undergoing rehabilitation after radiofrequency ablation (RFA) targeting medial branch nerves. Which factor would indicate the STRONGEST potential for pain relief following the RFA procedure?
A patient is undergoing rehabilitation after radiofrequency ablation (RFA) targeting medial branch nerves. Which factor would indicate the STRONGEST potential for pain relief following the RFA procedure?
What is the PRIMARY goal of a laminectomy?
What is the PRIMARY goal of a laminectomy?
What is the MOST critical rehabilitation consideration immediately following a discectomy?
What is the MOST critical rehabilitation consideration immediately following a discectomy?
A patient is 2 weeks post-lumbar fusion. Which exercise should be approached with the MOST caution during this initial phase?
A patient is 2 weeks post-lumbar fusion. Which exercise should be approached with the MOST caution during this initial phase?
According to the clinical perspective presented, for which condition does lumbar fusion show the CLEAREST benefit?
According to the clinical perspective presented, for which condition does lumbar fusion show the CLEAREST benefit?
What is the MAIN mechanism by which Radiofrequency Ablation (RFA) reduces pain?
What is the MAIN mechanism by which Radiofrequency Ablation (RFA) reduces pain?
A patient is considering an epidural steroid injection for nerve-related pain. What is the MOST accurate summary of the evidence regarding its effectiveness?
A patient is considering an epidural steroid injection for nerve-related pain. What is the MOST accurate summary of the evidence regarding its effectiveness?
During the rehabilitation of a patient who underwent a laminectomy, which exercise type requires careful monitoring and possible modification in the initial 8-12 weeks?
During the rehabilitation of a patient who underwent a laminectomy, which exercise type requires careful monitoring and possible modification in the initial 8-12 weeks?
The primary aim of reviewing common lumbar spine procedures is solely to understand surgical techniques.
The primary aim of reviewing common lumbar spine procedures is solely to understand surgical techniques.
Rehabilitation protocols following all lumbar spine procedures are universally standardized, requiring minimal individual patient adjustments.
Rehabilitation protocols following all lumbar spine procedures are universally standardized, requiring minimal individual patient adjustments.
Knowledge of common lumbar spine procedures is irrelevant for physical therapists focusing on non-operative management of lumbar pain.
Knowledge of common lumbar spine procedures is irrelevant for physical therapists focusing on non-operative management of lumbar pain.
Clinical pearls in rehabilitation primarily focus on accelerating the return to sport, regardless of the specific lumbar spine procedure performed.
Clinical pearls in rehabilitation primarily focus on accelerating the return to sport, regardless of the specific lumbar spine procedure performed.
An overview of lumbar spine procedures is sufficient to comprehensively manage all post-operative rehabilitation cases without needing to consider specific procedural nuances.
An overview of lumbar spine procedures is sufficient to comprehensively manage all post-operative rehabilitation cases without needing to consider specific procedural nuances.
Epidural steroid injections primarily target the dorsal root ganglia to alleviate nerve-related pain.
Epidural steroid injections primarily target the dorsal root ganglia to alleviate nerve-related pain.
According to a meta-analysis by Yang et al. (2020), epidural steroid injections provide significant functional improvement compared to other conservative treatments for lumbar pain.
According to a meta-analysis by Yang et al. (2020), epidural steroid injections provide significant functional improvement compared to other conservative treatments for lumbar pain.
Rehabilitation protocols following facet joint injections typically emphasize extension-based exercises initially to restore range of motion.
Rehabilitation protocols following facet joint injections typically emphasize extension-based exercises initially to restore range of motion.
Radiofrequency ablation aims to enhance nociceptive signals by stimulating nerve endings around the facet joints.
Radiofrequency ablation aims to enhance nociceptive signals by stimulating nerve endings around the facet joints.
A Medial Branch Block is performed after Radiofrequency Ablation to confirm the effectiveness of the nerve destruction.
A Medial Branch Block is performed after Radiofrequency Ablation to confirm the effectiveness of the nerve destruction.
Discectomy is highly effective in reducing both back pain and neurological deficits, making it a comprehensive solution for lumbar disc issues.
Discectomy is highly effective in reducing both back pain and neurological deficits, making it a comprehensive solution for lumbar disc issues.
Following a discectomy, patients are typically advised to adhere to strict limitations on movement and weight-bearing for at least six weeks to ensure proper healing.
Following a discectomy, patients are typically advised to adhere to strict limitations on movement and weight-bearing for at least six weeks to ensure proper healing.
Laminectomy involves the removal of the lamina and vertebral body to widen the spinal canal, primarily addressing foraminal stenosis.
Laminectomy involves the removal of the lamina and vertebral body to widen the spinal canal, primarily addressing foraminal stenosis.
After a laminectomy, rehabilitation programs should initially prioritize extension-based exercises to counteract flexion postures often adopted by patients with spinal stenosis.
After a laminectomy, rehabilitation programs should initially prioritize extension-based exercises to counteract flexion postures often adopted by patients with spinal stenosis.
For patients undergoing lumbar fusion, restrictions on Bending, Lifting, and Twisting (BLT) are typically limited to the first 2-3 weeks post-surgery to facilitate early mobilization.
For patients undergoing lumbar fusion, restrictions on Bending, Lifting, and Twisting (BLT) are typically limited to the first 2-3 weeks post-surgery to facilitate early mobilization.
Flashcards
Objective of presentation
Objective of presentation
Review common lumbar spine procedures to inform rehab strategies.
Rehab considerations
Rehab considerations
Understanding surgical approaches and techniques.
Presenter
Presenter
Adam Squires, PT, DPT, Cert DN, Cert SMT
Presenter specialization
Presenter specialization
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Clinical Pearls
Clinical Pearls
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Epidural Steroid Injection
Epidural Steroid Injection
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Facet Joint Injection
Facet Joint Injection
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Radiofrequency Ablation (RFA)
Radiofrequency Ablation (RFA)
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Discectomy
Discectomy
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Laminectomy
Laminectomy
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Lumbar Fusion
Lumbar Fusion
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Post Injection Activity
Post Injection Activity
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Discectomy Rehab
Discectomy Rehab
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Laminectomy Rehab
Laminectomy Rehab
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Lumbar Fusion Rehab
Lumbar Fusion Rehab
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Lumbar Spine Procedures
Lumbar Spine Procedures
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Epidural Injection Efficacy
Epidural Injection Efficacy
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Epidural Injection Outcomes
Epidural Injection Outcomes
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Facet Joint Injection Aim
Facet Joint Injection Aim
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Medial Branch Block Purpose
Medial Branch Block Purpose
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RFA Rehab Focus
RFA Rehab Focus
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Discectomy Effectiveness
Discectomy Effectiveness
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Laminectomy Goal
Laminectomy Goal
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Lumbar Fusion Limitations
Lumbar Fusion Limitations
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Lumbar Fusion Rehab Focus
Lumbar Fusion Rehab Focus
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Lumbar Fusion Precautions
Lumbar Fusion Precautions
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Study Notes
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- Common lumbar spine procedures and rehab considerations are discussed
Objectives
- Overview common lumbar spine procedures will be provided
- Clinical advice will be given regarding rehabilitation following common lumbar spine procedures
Epidural Steroid Injection
- Targets nerve-related pain
- Injection into epidural space helps affect nerve roots
- Systematic Review (Oliveira et al., 2020) found marginal effectiveness in reducing pain compared to placebo
- Meta-analysis (Yang et al., 2020) showed a significant difference in pain relief versus conservative treatment, but no significant difference in improvement of function
- Rehab considerations include avoiding intense activity for 24-48 hours post-injection
- No specific limitations in motion or strength training, interventions guided by patient pain, abilities, and goals
Facet Joint Injection
- Targets facet joints to relieve mechanical back pain
- "The clinical evidence for the efficacy of facet joint injections is considered limited" (Won et al 2020)
- Rehab considerations are the same as epidural injections
- Focus on flexion-biased movements initially, with restoring extension being key
Radiofrequency Ablation (RFA)
- Targets medial branch nerves around the facets
- Destroys nerve endings to reduce nociceptive signals
- Physician performs a medial branch block to test for potential efficacy
- Evidence suggests good efficacy for pain relief, especially if the medial branch block was effective
- Rehab considerations similar to injections, but physician protocol may dictate longer period of relative rest
- Manage post-intervention pain and soreness; reintroduce movement and progress according to patient tolerance
Discectomy
- Surgical removal of part of a disc
- Aims to relieve pressure on nerve root
- Effective for reducing leg pain and neurological deficits
- Mixed efficacy for back pain
- Rehab considerations involve managing post-operative pain
- Generally very few movement or weight limitations
- Interventions guided by patient's pain, abilities, and goals
Laminectomy
- Surgical removal of lamina, including the spinous process
- Decompresses the central canal
- Commonly performed for Spinal Stenosis
- Multiple levels may require fusion
- Rehab considerations include initial limitations into extension
- Focus is given to flexion-biased exercises and hip mobility exercises
- Core (anterior and posterior chain) strengthening is important
- End-range strengthening should be limited to 8-12 weeks
Lumbar Fusion
- Clinical perspective by Harris et al 2018
- "Available evidence does not support a clinical benefit" for back pain associated with degeneration or thoracolumbar burst fractures
- "Unclear" benefit for spondylolisthesis
- "Improves mobility and neurological outcome" for metastatic carcinoma with spinal cord compromise
- Surgeons typically have a specific protocol
- Recovery process may start immediately or wait 2-3 months post-surgery
- Avoiding Bending, Lifting, Twisting (BLT) is generally recommended for 6-12 weeks
- Core and hip strengthening is important
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Description
An overview of common lumbar spine procedures is provided. Clinical advice is given regarding rehabilitation following these procedures. Epidural steroid and facet joint injections relieve pain, but rehab requires avoiding intense activity for 24-48 hours post-injection.
