Dear mhg-ga,
I'd like to start by addressing your last question first:
4. Could you provide the name and address of a physician that could be
utilized as an expert regarding an anterior cervical discectomy and
fusion with instrumentation, including the risks involved,
complications that arise, the anticipated course of recovery, the use
of instrumentation, and the treatment involved with recovery and any
complications?
Dr. Edward D. Simmons.
Simmons Orthopaedic & Spine Associates
Office Address:
235 North St
Buffalo, NY 14201-1401
Office Phone: (716) 882-0035
Other Office Phone: (800) 699-9314
Fax: (716) 882-3032
E-mail: simmonsortho@worldnet.att.net
Website: http://www.simmonsortho.com
Dr. Edward D. Simmons is certified by the American Board of
Orthopaedic Surgery and is a Fellow of the American College of
Surgeons and the Royal College of Surgeons of Canada. Dr. Simmons is
also an Associate Clinical Professor of Orthopaedic Surgery at the
State University of New York at Buffalo.
His publications include over 50 scientific articles and textbook
contributions ? including (with Dr. Susan M. Liew and Yinggang Zheng)
?The Effect of Graft Resorption on the Clinical Results in Anterior
Cervical Keystone Fusion.?
Dr. Simmons is also a Fellow of the American Academy of Orthopaedic
Surgeons, the American Orthopaedic Association, the Scoliosis Research
Society, the International Society for the Study of the Lumbar Spine,
the Cervical Spine Research Society, and the North American Spine
Society, as well as others. He is on the Editorial Board of the
Journal of Spinal Disorders and Techniques, the Spine Journal, and
SPINE, and is a consultant reviewer for the Journal of Bone and Joint
Surgery.
With respect to your other questions:
1. Should physical therapy be prescribed for a patient who has
radiographic findings of graft resorption eight weeks following an
anterior cervical discectomy and fusion with instrumentation?
What are the pros and cons of such a prescription?
Graft resorption refers to the degradation of surgically placed
material that was intended to reconstruct a defect. Graft resorption
is a complication of some discectomy and fusion techniques.
Physical therapy probably should be prescribed. While physical
therapy takes many forms, rehabilitation plays a vital role in patient
recovery following spine surgery. (Bhatnagar et al, 1) The nature and
duration of such physical therapy will vary from patient to patient.
1 (a) If physical therapy is appropriate, how long should the patient
undergo physical therapy?
Bhatnagar et al point out that the postoperative rehabilitation of
patients undergoing spinal fusion depends on numerous factors,
including age of the patient, extent of spinal disease, association
and degree of neurologic involvement, duration of symptoms, overall
debilitation of the patient, associated medical ailments, as well as
social background and psychological constitution of the patient.
Bhatnagar et al recommend, above all, a graded aerobic conditioning
program: walking in the early postoperative phase, low-impact
activities (stairmaster, stationary bicycling, swimming) after the
6-week follow-up, then stretching and strengthening programs after 3
months. For some patients, complex and stressful techniques (ski
machines, versa climber) may be appropriate. The authors do not
advocate higher impact aerobic modalities (running, jogging).
(Bhatnagar et al, 2.)
Radiographic findings of graft resorption should be taken into account
when prescribing appropriate physical therapy.
2. Should a cervical brace be prescribed for a patient who has
radiographic findings of graft resorption eight weeks following an
anterior cervical discectomy and fusion with instrumentation?
A cervical brace probably should be prescribed. Bhatnagar et al point
out the choice of external immobilization depends on biomechanical and
physiologic factors. The choice of orthosis depends on the length of
fusion, type of fixation, quality of bone stock, amount and type of
bone graft, the patient's healing potential (nutrition, smoking), and
other factors (Bhatnagar et al, 3.)
What are the pros and cons of such a prescription?
Bhatnagar et al review several cervical spine braces and orthoses.
Minimal control is achieved with soft collars. Philadelphia collars
provide intermediate control in flexion and extension, but less in
axial rotation. The Yale brace is the most restricting of the
non-halo orthoses. Maximum control of the cervical spine is obtained
with the Minerva jacket and halo apparatus. The authors do not
recommend the halo vest or Minerva cast unless absolutely necessary
because of complications such as pain, infections, and patient
acceptance and compliance. (Bhatnagar et al, 3.)
3. Should a muscle stimulator be prescribed for a patient who has
radiographic findings of graft resorption eight weeks following an
anterior cervical discectomy and fusion with instrumentation?
An electrical muscle stimulator may be prescribed. Bhatnagar et al
suggest that pain reduction modalities such as electrical muscular
stimulation can hasten recovery. (Bhatnagar et al, 4.) The
combination of modalities used will vary from patient to patient
depending on the source of pain and intended result.
Pain reductions modalities include heating devices, cryotherapy,
phonophoresis, electrical muscular stimulation, and transcutaneous
electrical nerve stimulation (TENS). None needs to be used long-term.
(Bhatnagar et al, 4.)
What are the pros and cons of such a prescription?
Bhatnagar et al point out that electrical muscular stimulation may
result in a significant decrease in pain by increasing blood flow and
interfering with the creation of spasm. It also initiates contraction
of the stimulated muscle and can increase muscular strength.
(Bhatnagar et al, 5.) Increasing muscular strength is a principle
goal of physical therapy following spine surgery.
Resources used:
"Spinal Fusion and Rehabilitation Aftercare" by Mohit K. Bhatnagar et
al. http://www.simmonsortho.com/literature/spinalfusionandrehab/spinalfusionandrehab.html)
"American Academy of Orthopaedic Surgeons"
http://www.aaos.org
"LexisNexis"
http://www.lexis.com
"Simmons Orthopaedic & Spine Associates"
http://www.simmonsortho.com
In addition, here are some good links to websites that have
information on medical procedures and physicians:
"American Medical Association"
http://www.ama-assn.org
"United States National Library of Medicine Health Information"
http://www.nlm.nih.gov/hinfo.html
My search strategy involved finding the expert first. I have a pay
subscription to LexisNexis and searched for experts in the field.
This information comes up in court cases, articles, and medical
specialties.
Once I found my expert, Dr. Edward D. Simmons, I went to the American
Academy of Orthopaedic Surgeons website and searched for his contact
information.
On his website, I found a series of articles that included the article
that answered your first few questions.
I hope this helps. |
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