Surgeon -physiotherapist relation.

[emad]

Hi all;

Just ,now , i have assessed this case .

Male 55 years old with a history of both UL numbness 3 years , the left was more . He was diagnosed as C 4 disc protrusion .operated in 14-8-2004.

Before the operation

numbness of both UL associated with reffered pain, left more ,Weakness of Left lower limb which result even in his gait disturbance and dependant in his gait and walking.

Good baldder and bowel control.

After operated
I have NOT read any references from the Surgon , only MRI ,CT scan reports .i found

Numbness increased after the operation
weakness of the left lower limb improved suddenly after the operation , even his gait become independant .good baldder and bowel comtrol as before the operation .
Numbness increases in the morning
pain decreased after the operation in both UL.

Neck Motions
Now , passed 2 weeks since the operation performed , the Surgeon asked the Patient to put on solid collar ( as he called), no motions at all , putting on the Collar 24 hours /day ,7 days a week for six weeks .

While i was assessing the Patient we called the Surgeon via Telephone to improve communication process between us ,me and him .

He dealt with as an order to avoid motions in neck , do as i want both lower limbs and upper limbs.

Crisis
What are your views , and what i can do in this stage .
i can NOt assess at all the cervical.
By the way , i have NOT seen the patioent before operated.

cheers
emad

[nari]

emad

What did the surgeon actually do? Discectomy?Laminectomy? Both? or fusion? Sounds like cord compression, which may have meant fusion.

Sounds like he was concerned about stability with such a hefty collar regime. Surgeons vary a lot, but if it was a straightfoward discectomy, a collar should not be needed for more than a couple of weeks, if at all.

Is he a conservative surgeon?
You have a right to know more about his rationale/protocols.
But in the end, if he wants total immobilisation for 6 weeks, you have not much choice in the matter.
Try to discuss his reasoning with him, if you can.


Nari

[emad]

Hi

you are right nari ;

I think the issue no more good communication ,but The surgeon is living in Alexanderia , and i am away 300 km.

Regarding the case , i think after removal of this collar after 6 weeks ,he is going to order another soft collar .

I think i have the right to mobilise at least lumbar and thoracic regions as physiological mobilisation.

cheers
emad

[nari]

emad

I don't see why not.

Check out the ULNT status of the upper limbs, perhaps, as well.

Isometric work in the head/neck within the collar may be useful, but there is no evidence that I have found that it is of any value if there is no movement involved.
You might check SLR too.

Nari

[emad]

Yes,

i assessed SLRT , both lower limbs ,the test was negative until 60 degrees of flexion ,slight numbness with dorsi addation ,in the gastro region.

Regarding ULTT And Neiral Mobilis :

I asked the patient to perform slides on both elbow and wrists (3 repitations)
encourged standing to sitting activity and its opposite.

But , sitting to lying in bed is difficult for the patient, because of that bad collar which makes him move as one stick .
Also ,i performed active ex for both lower limbs.

In my intial assesment i spend with the consumer 90 minutes ,to assess ,educate &teach ,and communicate with the surgeon.

cheers
emad