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Post op discectomies

 
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Post op discectomies - January 7, 2005 10:46:00 AM   
tf8560

 

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What has been your experience in rehabbing post op discectomies?
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Re: Post op discectomies - January 7, 2005 11:51:00 AM   
BRuchin

 

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What stage of rehab? What type of fusion was done during the surgery?

You have to keep in mind hyper and hypo mobilities. the patient will be hypermobile or become hypermobile at the segment above and below the fusion.

I have seen great success with these patients. One big issue i have seen is making sure the patient knows that they can move and return to a normal life. psychologically, it is harder for them.

For rehab, tons of stability to the entire spine, not just the affected area.

Manual Therapy can be very beneficial to the patient to learn to recruit the muscles for the stabilization and for pain control.

Good Luck.

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Re: Post op discectomies - January 7, 2005 8:52:00 PM   
PTupdate.com


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I personally work the H.LL out of the soft tissue and scar, mainly to prevent the superficial layers from binding to subsequent layers. Of course, work on the obvious, such as pelvic weakness, ergonomics, any remaining neural hypomobility/adhesion issues, inflexibility, body mechanics, myotomal weakness, and definitely cardiovascular.

A study in Spine a few years ago found that those who had microdiscetomy and no instructions afterwards, fared the best!! In other words, get back with your life and no restrictions and you will probably do just fine.

John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]

_____________________________

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www.PTupdate.com

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Re: Post op discectomies - January 11, 2005 7:49:00 AM   
eam

 

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I agree with John. I am treating a post-op discectomy from over a year ago -I have discussed him on the NOI website under "dural scarring". I saw him over 1 year post op. He had recurrence of symptoms and had been to other PT's before. Soft tissue and scar-very important as it good neural mobility, TRabd as well as multifidus. Good luck!
Erica

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Re: Post op discectomies - January 12, 2005 1:02:00 PM   
tf8560

 

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The patients I am describing are lumbar discectomies without fusion. It seems that many (in general..not only with my specific experience but in conversations with other PT's)is that many experience initial relief only to have their previous symptoms return after 3-4 months.

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Re: Post op discectomies - January 12, 2005 3:38:00 PM   
Shill

 

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TF8560,
I can tell you that I have seen these recurrences as well, far too frequently than it should be. I can chalk it up to vague post op instructions. Telling folks to "take it easy" after a discectomy isnt good enough. This does not protect the rift in the disc, ligament, etc, from the surgical excision. I firmly believe that these folks go home, sit around, flex the bejeezus out of their spines by sitting around, and start themselves down the road to reinjury. To one person I saw, "take it easy" was loosely translated to "build a deck". Patients need CLEAR, concise recommendations. Its clear to us, its clear to the docs, but the patients dont do this stuff day in and day out. They simply dont know.
"Dont sit too much" is also not clear enough. Strict guidelines for motion, duration and frequency of motions, and activity are a must. If you read the studies on followups after discectomy, lots of these folks still have a fair amount of pain. To me, this is unacceptable. Especially if some clearer guidelines and limitations could have prevented this.
Time for a study.
Do clear, concise guidelines on progressive return to activity, including gradual progression to flexion activities, improve outcomes following lumbar discectomies? Havent seen it done yet. Has anyone else?

Steve

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Re: Post op discectomies - February 3, 2005 6:30:00 AM   
JLS_PT_OCS

 

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Steve-

I haven't seen any outcomes data, either.

An area ripe for investigation. I would say that for every postop discectomy patient that I have seen that had a recurrence of symptoms, I have also seen one that told me they didn't do any therapy and they did fine.

Perhaps there is a subgroup of patients that can be indentified that is at greater risk for a recurrence, and therefore should definitely be sent to PT?

My postop approach is the same as others posted, the ones I have seen do pretty well (though as I said, I'm sure there are plenty out there who never see me and do great also).

J

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jasonsilvernail@gmail.com

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Re: Post op discectomies - February 3, 2005 12:36:00 PM   
Yogi

 

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Jason, I know you are right, there are discectomy pt's who do fine w/o therapy, in fact, this might sound like heresy, but I see no more need for post-discectomy therapy than I do for post-cholesectomy therapy.

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Re: Post op discectomies - February 4, 2005 7:58:00 AM   
JLS_PT_OCS

 

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Yogi-

Agreed. I think we need to advocate for patients and our profession, but perhaps this is an area in which there is some degree of overutilization?

I am sure if you talk with a neurosurgeon, they may have some opinions as well.

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Jason Silvernail DPT
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Certified Strength and Conditioning Specialist
www.silvernailstudios.com
jasonsilvernail@gmail.com

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Re: Post op discectomies - February 4, 2005 8:51:00 AM   
Yogi

 

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Good idea, Jason, I will try to remember to do that at the first opportunity. When I worked in inpt. rehab, it used to bug me that it was hard to get enough rehab. time for a cva and a spinal fusion seemed to stay for ages. That didn't seem right.

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Re: Post op discectomies - February 4, 2005 11:54:00 AM   
JLS_PT_OCS

 

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I hear you on that one...

That really should be a case of the evidence driving the care there, especially as it is so expensive (meaning inpnt rehab).

I know if "I" were running an insurance company, outcomes is what I'd use to make those length of stay type decisions...though perhaps more of that goes on than is obvious to me.

_____________________________

Jason Silvernail DPT
Board-Certified in Orthopedic Physical Therapy
Certified Strength and Conditioning Specialist
www.silvernailstudios.com
jasonsilvernail@gmail.com

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Re: Post op discectomies - February 4, 2005 1:14:00 PM   
Yogi

 

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Jason, I do Home Health on the side, usually just evals. for PTA's (that's a whole nother discussion, and this is off the thread subject somewhat), and I have had 2 Pt's that were true rehab, and progressing with treatment, and the agencies wouldn't recertify them, yet just plain old chronic and deconditioned ones get re-certed all the time. Nothing is obvious to me. Except I'm sure dollars drive decisions.

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Re: Post op discectomies - February 4, 2005 7:15:00 PM   
Jon Newman

 

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Here's some references. I've only read the abstracts. There is one on exercise.

[URL=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12807041]link 1[/URL]
[URL=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12394667]link 2[/URL]

[URL=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11409309]link 3[/URL]

[URL=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10908492]link 4[/URL]

[URL=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10851101]link 5[/URL]

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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]

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Re: Post op discectomies - February 5, 2005 3:30:00 PM   
tr6454

 

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Jon ,
Thanks, the links you provide confirms that having a discectomy may not address all of the patients underlying pathology. I am not satisfied that at 3 months p op the patients pain is decreased. That is not 'doing just fine'. Often there is other pathology that a PT needs to address.
I don't think it overutilization to address the same issues in the spine that we do in other joints. Let the surgeons be happy with their short term pain relief. Let's be more concerned with what we can do to help restore mechanics and function so patients can avoid the second surgery at the next level in three - five years.

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Terry

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Re: Post op discectomies - February 5, 2005 9:02:00 PM   
Jon Newman

 

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Hi Terry,

Your welcome. Here's one more along your line of thought.

[URL=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9530792]link 6[/URL]

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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]

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Re: Post op discectomies - February 7, 2005 8:56:00 AM   
JLS_PT_OCS

 

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Well said, Terry.
Agreed.

_____________________________

Jason Silvernail DPT
Board-Certified in Orthopedic Physical Therapy
Certified Strength and Conditioning Specialist
www.silvernailstudios.com
jasonsilvernail@gmail.com

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Re: Post op discectomies - February 7, 2005 9:20:00 AM   
Yogi

 

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Six weeks after surgery, back strengthening was useful. How many of you get referrals six weeks post-op. I imagine back strengthening a year post op is beneficial also. And ten-years pre-op. But who's paying and where's the referral coming from? As Jon says, here's a link, and maybe a possible thread subject. http://WWW.spineworks.com

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Re: Post op discectomies - February 7, 2005 9:41:00 AM   
Yogi

 

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Maybe for greater efficacy, here's another link. Http://superslow.com Jon, I used to enjoy looking at the spinal surgery literature. There seems to be a bell-curve as new procedures come along. Thanks for the newer relevant reviews.

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Re: Post op discectomies - February 7, 2005 9:55:00 AM   
Yogi

 

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Another, nothing new, except page 2 and 3 and the Sarno part may be of interest to some. http://msnbc.msn.com/id/4767783/

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