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lumbar fusion and laminectomy
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lumbar fusion and laminectomy - February 26, 2006 6:24:00 AM
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acutept
Posts: 4
Joined: April 2, 2005
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Hi,
I work on the orthopedic floor and I see patients with lumbar fusion and laminectomies on a daily basis, most of the time on post-op day 1. We teach our patients some basic movement precautions after the surgery, like log-rolling to get out of bed, sitting on a chair/seat which is a little high to avoid bending over..etc.
I wanted to know what other precautions/restrictions should be follwed after these kind of surgeries.
All input is welcome.
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Re: lumbar fusion and laminectomy - February 26, 2006 6:40:00 AM
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JLS_PT_OCS
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Huge difference between a fusion and a laminectomy.
Surely your surgeon has a protocol for the fusion people based on the type of fusion (anterior interbody, transverse, cage, etc.)?
If not, you should explore this.
For the laminectomy folks, just get them moving and walking and out the door, so they can get their outpatient rehab.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: lumbar fusion and laminectomy - February 26, 2006 9:10:00 AM
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mcap56
Posts: 617
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I agree. There is a huge difference between laminectomy and fusion. Your surgeons should provide protocols. The protocols often vary and sometimes make little sense. But you should have that cover in case something goes wrong.
If you need further guidance, I have found the book......rehabilitation protocols for surgical and non-surgical procedures by McFarland and Burkhart to be helpful. They have several detailed outpatient and in patient protocols for a variety of procedures. They also have both preoperative and postoperative protocols. In some cases you only see the patient preoperatively and won't have access to them until they come for outpatient therapy.
Marc
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Re: lumbar fusion and laminectomy - February 26, 2006 1:19:00 PM
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tr6454
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It may be symantics but when I hear that the surgeon should provide us with protocols regarding rehabilitation or return of function I cringe. I hope we are not still presenting our profession in this light. At the very least this should be something that both the PT and the surgeon can discuss and develop. It is a great opportunity for us to educate them on our ability to analyze function and to provide our guidelines on activities, exercise, etc.
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Terry
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Re: lumbar fusion and laminectomy - February 27, 2006 3:18:00 AM
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FLAOrthoPT
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i don't know, post surgery rehab is kind of cook bookish and does matter what the doc wants, the last thing you want is for YOU to be blamed for failed surgery. I hate post surgical rehab, think it's mindless, hence I do not do it anymore, but I'd say if I got a RTC who has full ROM but the doc wants him to have passive only, I's stick to that. Unless I had a very detailed op. report, or was AT the surgery, I wouldn't stray too much from an MD prescription post surgery. Terry, what you meant to say I am sure, is that I hope our profession in outpatient is beyond only treating post surgical candidates...but the ones which are, should be treated pretty exact i.m.o.
Ben
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Re: lumbar fusion and laminectomy - February 28, 2006 5:53:00 AM
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tr6454
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Ben
First, what's imo? If it has anything to do with orders I'm against it! I don't work at McD's and I'm not in the Army anymore. PT's should accept referrals and provide consultations. Just terminology? Maybe, but it has to start somewhere.
Post operative rehabilitation should be a collabortive effort, I wouldn't dream of telling a surgeon how to approach or perform the surgery. And likewise many surgeons have told my patients (appropriately), that PT will decide when they can WB, DC crutches, remove the sling, etc etc.
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Terry
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Re: lumbar fusion and laminectomy - February 28, 2006 8:01:00 AM
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ehanso
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An operative report can be very helpful. This gives me an idea what was done. It is also a good point of reference to begin a discussion with the surgeon about expectations and rehab options.
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Re: lumbar fusion and laminectomy - February 28, 2006 8:04:00 AM
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truthseeker
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Terry, I am in total agreement with you. What I want to know from the surgeon is what NOT to do. for example, if someone has had a rct, it is different than someone who has had a "massive rct" I treat them differently as should everyone because the consequences of going too quickly are more permanent with the massive tear.
We are the experts in function. Heck, most orthopods never even watch their patients walk. How can they be expected to know everything that they know, AND know more about what we do than WE do.
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Re: lumbar fusion and laminectomy - February 28, 2006 8:12:00 AM
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Synergy
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From: Texas
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Terry,
IMO = in my opinion :)
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Chris Adams, PT, MPT
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Re: lumbar fusion and laminectomy - February 28, 2006 8:15:00 AM
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nari
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From: Australia
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acutept,
Do you have any record of what the previous PT did with lamis, fusions etc? Surely there is something written somewhere. If not, maybe you could start by asking the surgeons what they DON'T want done.
I spent 11 years with post spinal surgery patients and, like Ben, found it tedious. Fortunately it was only a small part of the neuro ward's work. I followed a protocol devised by PT and waved past the doctors for approval. They never objected to anything.
It was open referral for us, so we chose who we saw and who we didn't.
The nurses did the mobilising out of bed (instigated by PT) and fitted a light sacral support if the doctor thought it necessary. I banned all types of walkers and that improved things quite a bit.
Education was most important,plus neural-type work; also TA.
I totally agree with Terry. Waiting for doctors to set protocols is not really on. PTs set them; the docs can query the movements they might get nervous about and we explain why we want the patient to do them. It's really not difficult.
Nari
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Re: lumbar fusion and laminectomy - February 28, 2006 9:30:00 AM
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mcap56
Posts: 617
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From: New York, NY
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I am always in favor of PTs creating their own protocols. I have been advocating this strongly, expecially on this board. But there are issues to consider and limits that exist:
1. Short of the op report, we don't really know what the surgeon did. There are different approaches and different types of hardware that are used. Each may dictate different precautions. Calling ths surgeon to check on contraindications and restrictions is a good compromise.
2. Although I find many post-operative protocols to be substandard, you can not forget the environment we are in. The surgeon has referred a patient to you. You are legally bound by restrictions indicated by the surgeon.
3. Something may go wrong after surgery. We have all seen our fair share of "failed" surgery syndromes and record of sucess for back surgery in general is spotty at best. Many of the patients aren't even appropriate candidates. When there is an adverse outcome, and if there is litigation involved, you will be sued also. Would you really like to be in a deposition explaining why you deviated from protocol whether it mattered or not??
I fully support our move towards greater autonomy. I can not however, forget the context of the current system. The problem with back surgeries aren't restrictive protocols or instructions from the surgeon that are too rigid. The problem is back surgeries. So, when a surgeon decides to perform a fusion for DDD and pain, the mistake has already been made. I am not going to the barricades on that one trying to increase my autonomy.
Respectfully,
Marc
[URL=http://www.thebackpage.net]www.thebackpage.net[/URL]
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Re: lumbar fusion and laminectomy - February 28, 2006 10:10:00 AM
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JLS_PT_OCS
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Well said, Marc.
What I meant by protocol, was that I would hope the Ortho and PT had already established collaboratively a protocol for each condition.
If that hasn't happened yet, it should.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: lumbar fusion and laminectomy - March 1, 2006 9:09:00 AM
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mcap56
Posts: 617
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From: New York, NY
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Agreed. That is certainly the best way. The spine surgeons I have worked with over the years tend to be a little harder to get hold of than some of the others. Not sure why that is....probably coincidence. Perhaps they are always in depositions LOL!!!
marc
[URL=http://www.thebackpage.net]www.thebackpage.net[/URL]
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Re: lumbar fusion and laminectomy - March 3, 2006 7:46:00 AM
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tnt
Posts: 22
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From: Wisconsin
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Many good points here...just my 2 cents:
Communication with the surgeon is the best route, but as mentioned, not always feasible. I believe it is up to the surgeon to provide any instructions that he feels strongly about in the many avenues of paperwork and orders that must be filled out during the post-op process. If they fail to do so, it may very well mean that they expect us, as professionals to know what to do.....This is where we need to step up to the plate, people!
It is our job to be able to provide post-op care (or any care for that matter), based on experience, evidence and patient tolerance. We follow orders first, but in the absence of these orders, we need to know what to do. If something goes wrong, you will still have evidence-based treatment plans on your side to justify your actions. Have confidence in your training and skills, and "do no harm". Remember, many physicians don't want to or don't know how to direct therapeutic intervention. This, my friends, is why we exist.
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Re: lumbar fusion and laminectomy - March 3, 2006 12:23:00 PM
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jma
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From: NY
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The book by Maxey and McFarland are great sources of info, especially Maxey's book.
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