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cervical fusion
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cervical fusion - December 2, 2002 2:10:00 PM
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cozziew
Posts: 38
Joined: October 19, 2002
From: greenville sc us
Status: offline
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What about cervical traction after a fusion. It is about 8-9 p/s.
Thanks so much!
Any ideas of what to do with a pt that had L sided N&T and after the surgery the L sided things have diminshed but now has all of the Symptoms in the right with C5-C7 dermatome N&t
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Re: cervical fusion - December 2, 2002 4:40:00 PM
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coloradojulie
Posts: 413
Joined: November 10, 2002
From: colorado usa
Status: offline
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Those opposite sided symptoms may be related to some localized inflammation from the surgery itself. Some gentle nerve mobilizations on that side probably would be of help to prevent adhesions.
Also check the chest flexibility. Protracted scapula can create levator scapula tension and trigger points.
I treated two fusions recently at that level from the Steadman Hawkins Clinic and we didn't use traction. We trialed it pre-op only. I do some gentle manual traction in my attempts to restore flexion range of motion. Some practitioners advocate that before you can get any other motion, you have to restore flexion. I also did a lot of muscle release work and gentle joint mobilizations, statically and actively. Progressive isometric and isotonic exercises, short flexor strength work and eventual dynamic progression (jumping, jogging etc).
I think traction would be contraindicated until the bony fusion is established...in theory the problem is corrected and should no longer need distraction as the bone plug serves this function. Focus on restoration of ROM and strength as well as decreasing muscle spasm.
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Re: cervical fusion - December 2, 2002 5:37:00 PM
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PTupdate.com
Posts: 1490
Joined: October 8, 2001
From: Pittsburgh, PA USA
Status: offline
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As Julie indicates, traction would be contrindicated until bony union occurs. However, you did not mention the time frame since the fusion occurred, or is that 8-9 months post-surgery you mentioned?
Multiple studies are showing that the levels above and below the level of a cervical and or lumbar fusion have a 25% rate of significant degenerative change within 7-10 years. This is both joint and disc involved, with flexion and extension both causing increased force.
As you treat this patient, consider this, and make sure everything besides the directly adjacent levels is functioning properly. This may reduce the future problems.
Does the patient smoke? If so, there will be greater risk of non-union. Postural problems and ergonomic considerations? Poor cardiovascular status? All these and many other things should be addressed.
John Duffy, PT OCS [URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
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