Post Surgical Cervical -Lumbar Spine Continuing Education

Advanced Rehabilitation for Cervical and Lumbar Spine Procedures Course Objectives

Upon completion of this course the participant will be able to:

• Identify key references for rehabilitation pre and post surgical spine intervention.
• Identify the importance of early intervention for surgical spine for ACF patients and other surgical procedures.
• Discuss a variety of options to approach spine pathologies, neurological problems, and musculoskeletal problems that accompany surgical procedures.
• Recognize the theories of plasticity as applied to the spinal cord, nerve pathways.
• Identify techniques to improve nerve function and facilitating muscles to support the spine.
• Recognize the importance of the team approach and communication with the surgeons.
• Recognize and train a patient on key postural alignment with and without activities.
• Select and plan spine specific interventions, assess effectiveness, phase in prevention for patients.
• Describe new regenerative medicine techniques for spinal structure repair vs. removal or replacement.
• Identify the benefits of regenerative medicine and the importance of stressing specific structures to rebuild the target tissue.
• Identify the techniques utilized for specific spinal surgeries and develop a protective progressive rehab program to optimize function and healing.
• Discuss some exceptions to rehab spinal protocols and identify techniques to utilize to safely progress the patient.
• Discuss the importance of muscle balance and how specific imbalance affects the foraminal opening leading to neurological symptoms.
• Integrate pain management approaches, with active recovery when possible from acute to chronic.
• Describe the importance and applicability of motor control exercise for optimal recovery of spinal disorders and spinal protection.
• Address neurologic components of recovery utilizing current evidence on management.
• Describe needed cardiopulmonary therapies to help with the overall surgical and musculoskeletal recovery.
• Utilize approaches to maximize joint mobility without pain for restoring spinal function.
• Identify appropriate treatments for an activity based management rehab program.
• Educate surgical spine patients on exercise, mobility and strengthening guidelines.
• Teach post surgical patients how to appropriately progress ADL’s

Learn from the Expert - Carol McFarland PT, PhD, OCS

Carol McFarland PT, PhD, OCS has been a full time practicing PT since 1975, in Texas since 1980 in acute, outpatient and home health settings. She and her husband owned a private practice for a number of years, during which she obtained Orthopedic Clinical Specialist (OCS) certification from the American Board of Physical Therapy Specialties in 1990. This has been renewed twice and extends through 2018. For the past 35 years she has been working mostly with orthopedics and has done specialized work with spine. She was active with American Back Society which helped develop post surgical protocols for spine with colleagues over several years. These protocols were published in a non peer reviewed format in 2001. The work with these protocols also opened a door for her to teach seminars on post surgical spine rehabilitation for North American Seminars for the past 16 years. Between this teaching and clinical practice, she decided to complete a PhD in Physical Therapy in 2012 with a dissertation study that was a clinical study of early therapy intervention after anterior cervical fusion. She has continued research interests in the area of exercise and activity based management of orthopedic disorders, and has published studies in the Journal of Geriatric Physical Therapy and in the Journal of Back and Musculoskeletal Research. She is also active in the Texas Physical Therapy Foundation for research and more recently North American Spine Foundation, and North American Spine Society.

Overview of the Course and Introduction to the Contributing Physicians

• Background for surgeons contributing to the course.
• Aaron K Calodney, MD, Board Certified Anesthesiologist.
• Guys O. Danielson, MD,Board Certified Neurosurgeon, first surgeon to use ProDisc.
• Dr. Stuart Crutchfield,MD, Board Certified Neurosurgeon.
• Importance of early intervention and an overview of the course.
• Discussion of randomized clinical trial for ACF patients and early interventions.
• Background for surgeons contributing to the course.

Evidence For Active Recovery, Functional Loss Characteristics, Microdisc Surgery

• Active recovery, functional loss characteristics.
• Microdisc Surgery
• Four characteristics of functional loss.

Pre and Post Surgical Evaluation, Treatment and Surgical Descriptions

• Evaluation and testing for inpatient specific to surgery.
• Spinal control patient education, dynamic control.
• Dr Calodney, MD-Biological injections, fibrin, platelet-rich plasma injection, stem cell injection.
• Dr Calodney, MD-IDET
• SAID principle
• Case study: herniated nucleus pulposus
• Segmental stabilizers
• Dr. Crutchfield, MD-Spinal stenosis surgical procedure, preservation of soft tissues, and active therapy treatment.
• Dr. Crutchfield, MD-Minimally invasive lumbar decompression surgery procedure.
• Dr Calodney, MD - Discography
• Dr Calodney, MD - Medial branch block
• Dr Calodney, MD - advice for clinicians
• Active and assisted approaches that assist with posterior element pain.
• Case study: Older patient with spinal stenosis
• Manual therapy for spinal decompression, demonstrations
• JOSPT clinical study on spinal decompression
• Unloading exercises and activities, demonstrations
• Problematic muscles that can impair recovery
• Self traction-demonstrations
• Postural strengthening, demonstrations

Testing, exercise prescription, and specific applications for spine rehab and progression.

• Evidence based resources
• Activity based management
• Repetitive movements
• Facilitation of flexibility
• Thoracic spine therapeutic exercises
• Demonstrations: rib cage routine, testing segmental stabilizers, interim testing
• PCT test-interem test
• Return to lifting protocols

Working on Posterior Shoulder Girdle and Postural Strength with Weights

Demonstrations:

• Posterior girdle routine
• Strengthening series:
  • triceps
  • rotator cuff
  • hip hinge with exercises
  • weights
  • resistance band
  • rotary stabilization

Active Recovery for Imbalances and Restoring Functional Mobility

• Motor control
• Hodge’s motor control
• Demonstrations: stabilization, quadruped, dynamic and static strengthening.
• Devices utilized for advanced exercises.

Newer Alternatives to Repairing Disc Pathologies, Minimally Invasive Techniques, Regenerative Medicine

• Dr. Calodney, MD - presenting promising interventions in regenerative medicine.
• Dr. Calodney, MD - Treatment options for degenerative disc.
• Dr. Calodney, MD - Injection procedures
• Clinical studies
• Dr. Calodney, MD - Interventional biologics
• Dr. Calodney, MD - Mesenchymal stem cell injections

Specialized Treatments with Specific Therapy Follow Up

• Reasons for failed surgical procedures-Guy Danielson, MD
• Anterior cervical fusion
• Dr Crutchfield, MD - Are the paraspinals damaged or impaired with a posterior surgical approach?
• Dr Crutchfield, MD - Decompression versus fusion
• Dr Crutchfield, MD - Fusion surgery
• Dr Crutchfield, MD - Is there a greater risk of displacement from a lordotic cage placed anteriorly?
• Dr Crutchfield, MD - which surgical approach results in less pain?

Dissertation Study on ACF

• Early intervention can help patients after anterior cervical fusion.
• Radiographic view of anterior cervical fusion showing anterior plate and screws.
• Instruction on how to manage or control the pain.
• Guidelines about how they can protect the surgery without causing any damage.

Patient Education and Muscle Training, Artificial Disc Replacements

• Essential to educate the patients for cervical spine muscle training.
• Demonstrations: Crown-up, scapular control, rotator cuff. Resistance band exercises, bow and arrow movement, double arm activity, rotation, gravitational tractio
• Post-op instructions, active recovery, segmental stabilizations, recruiting deep cervical flexors, traction forces for the c-spine.
• Mobility Work for the Spine, Rotation Techniques.
• Demonstrations: Series of exercises are done to help gain mobility through the cervicothoracic area.
• Thoracic spine self mobilization.
• Shirley Sahrmann’s wall exercises

Cardiopulmonary Training, Exercises and Mobility Techniques

• Cardiopulmonary training for any of the post-surgical patient.
• Circuit training is also helpful for cardio training.
• The American College of Sports Medicine Guide to Exercise Testing and Prescription.
• Borg Scale of Perceived Exertion Scales.
• Cardiovascular reconditioning and strategies.
• Training patients with COPD for recovery of cardiopulmonary endurance.
• Efficacy of in-home pulmonary rehab.
• Exercise demonstrations and manual mobility techniques.

Patient Instructions

• Demonstrations and step by step instructions on information provided to surgical spine patients.
• Guidelines for movement and lifting.
• Precautions
• Return to housework, ADL guidelines.
• Strengthening guidelines.

Additional Case Studies

• Posterior cervical fusion.
• Osteoporosis, compression fractures, Kyphoplasty and vertebroplasty, balance screen
• Multilevel fusion