Conditions after surgery, fractures and injuries

Rehabilitation after spinal surgery

Postoperative rehabilitation is carried out after microdiscectomy, decompression (laminectomy, foraminotomy), lumbar spinal fusion, anterior cervical discectomy and fusion (ACDF) or artificial disc replacement, fracture stabilisation, vertebroplasty or kyphoplasty, and scoliosis correction.

The doctor sets the extent and pace of loading according to the type of surgery, the surgeon’s instructions and the healing phase, especially after fusion, and monitors the neurological status and pain. Rehabilitation proceeds in phases: protection of the operated segment and education in ergonomics, gradual restoration of mobility, stabilisation and strengthening of the trunk muscles, and return to work and sport. Persistent or new pain after surgery calls for a new diagnostic work-up, not just continued therapy.

Vertebral fracture

The most common are osteoporotic compression fractures, which occur after minimal trauma or spontaneously, most often at the thoracolumbar junction. Traumatic fractures occur after a fall from a height or a road traffic accident.

The doctor assesses the stability of the fracture and the neurological status on the basis of X-ray, CT and MRI, which shows the biological stages of the fracture. With an osteoporotic fracture the cause must always be investigated with bone densitometry and laboratory tests, and a pathological fracture due to multiple myeloma or metastases is ruled out. Conservative treatment includes pain relief, a brace where indicated, early mobilisation, exercises for the trunk extensors and fall prevention. After an osteoporotic fracture, treatment of osteoporosis is also essential, because such a fracture is the strongest indicator of the risk of another one. The specialist physiatrist will prescribe medication for proper healing and to prevent further bone loss. Medicines from the groups of osteoanabolic and antiresorptive drugs help prevent new fractures.

Whiplash injury

An injury to the soft tissues of the cervical spine through an acceleration–deceleration mechanism, most often in a road traffic accident, graded according to the Quebec classification (WAD 0–IV). The doctor rules out a fracture and instability, and rehabilitation restores mobility early and prevents the condition from becoming chronic. Whiplash injury is often a matter for forensic medical assessment.

Spondylolysis in young athletes

A stress fracture of the vertebral arch (pars interarticularis), most often in the lower lumbar vertebrae, typically L5, in sports with repeated extension and rotation. The diagnosis is made by MRI or CT, and the doctor sets the period of offloading and a gradual return to sport.

Spinal cord injury

Traumatic or non-traumatic damage to the spinal cord with a complete or incomplete neurological deficit, classified on the ASIA scale (AIS A–E). Long-term rehabilitation focuses on independence, preventing complications and choosing assistive devices.