MINIMALLY INVASIVE SPINE SURGERY

TECHNIQUEOUTCOMES

OCCUPATIONAL THERAPY

TYPES

• SPINAL FUSION- Immobilization of vertebral bodies/motion segments with instrumentation

• DISKECTOMY- Spinal decompression from vertebral disk herniation. Removal of disk material relieves pressure on spinal cord/root nerves.

Advantages

• Less disturbance of soft tissues, nerves, and muscles during procedure

• Less scarring• Decreased length of stay post-operatively. • Less bleeding • Cosmesis (smaller incision)• Reduced pain and narcotic usage• Quicker return to normal activities

Disadvantages

• Requires use of fluoroscopy ( C or O arm) to achieve visualization

• Higher exposures to radiation from fluoroscopy• Longer surgical times• High learning curve for surgeons• Not suitable for all patients/cases• Exposes less bone surface area for fusions • More difficult dural repair if damaged

Potential Complication• Infection• Bleeding• Pneumonia/Lung problems• Anesthesia complications • Recurring symptoms• Pseudarthrosis• Hardware fracture• Implant/graft migration• Spinal cord/nerve damage• Post-operative DVT• Dural tear• Transitional Syndrome• Sexual dysfunction

Equipment/Instrumentation

Open vs. MIS

MIS Surgery Video

OT Following Surgery

• Instruction in the proper techniques for putting on/taking off your back/neck brace

• Reinforcement of BLT Precautions• Transfer procedures: to EOB, Bed to Chair, Bed

to Walker, and Walker to Toilet/Shower chair• Instruction in compensatory techniques for

ADL’s( sock aids, reachers, AE/AD devices)• Instruction in toileting, showering, self-care• Education for patient/family/care-givers

Assistive Devices

OT Back Surgery Video

Bed/Chair Positioning Precautions

• HOB elevated no more than 30 degrees• Log roll in bed to turn, never twist• Lie on back with pillow under legs• Lie on side, both knees bent with pillow between knees. Do not put

arms under head• Pillow behind back to prevent rolling• Avoid slouching in chairs, keep shoulders, hips, and ears aligned• Choose a chair that has good support• Avoid soft chairs, couches, and recliners• Keep feet flat on floor, and knees level with hips• Do not sit for too long, stand and stretch occasionally• To stand up, slide to edge of chair and use knees and hips to straighten• Use arms to help support and lift if possible

Questions

• References:• http://www.google.com/search?q=back+surgery+assistive+devices&clie

nt=safari&rls=en&tbm=isch&prmd=ivns&ei=5Jc6VJn4Ds-LyASHuYDACw&start=20&sa=N

• http://orthoinfo.aaos.org/topic.cfm?topic=A00543• http://www.aans.org/Patient%20Information/Conditions%20and%20Tre

atments/Minimally%20Invasive%20Spine%20Surgery%20MIS.aspx• http://umm.edu/programs/spine/health/guides/complications-of-spine-

surgery• http://www.understandspinesurgery.com/Articles/Read/Minimally-Invasi

ve-Surgery-(MIS)-for-Spinal-Problems• http://www.hopkinsortho.org/JHULumbSpineSurgeryGuide.pdf• http://www.basicspine.com/blog/minimally-invasive-spinal-surgery-used

/• http://www.practicalpainmanagement.com/treatments/interventional/

minimally-invasive-spine-surgery-who-can-it-help• http://www.zimmer.com/en-AU/hcp/spine/product/pathfinder-minimall

y-invasive-pedicle-screw.jspx• https://www.youtube.com/watch?v=QYXJv01SvyA• https://www.youtube.com/watch?v=2o00O0l1my4• http://www.ilcnsw.asn.au/items/357?topic_header=additional_info