Total Disk Replacement (TDR) Lumbar

  • (See DISD Clinical Protocol)
  • Follow up visit in 3 weeks
  • Narcotic pain control should be limited by 2 weeks post op.
  • NO NSAIDs
  • Ripcord brace for 2 weeks.
  • Core Trunk Stabilization should re-start at one months in the brace, 2-3 days per week for 6 weeks, followed by a therapist taught home exercise program.
  • Home walking program. Start immediately after surgery. By follow up, patient should be able to walk >l mile per day.
  • Return to work at 3 weeks.

Notes:

Back pain is usually moderate (3-6/10) for the first 3 weeks. Adult scoliosis patients expect to keep 3/10 level pain for years

Residual numbness in the leg or foot is not uncommon and can last for years.

Anyone who has leg pain or weakness they did not have before surgery should be

evaluated immediately and reevaluated with a PE, MRI w/ GAD, and or CT myelogram STAT! Do the above and call me. Book the patient into my clinic

within 24hrs for weakness, or 1-7days for pain, with the films completed for me to

review.

Scoliosis Reconstruction Post Op Protocol

  • (See DISD Clinical Protocol)
  • Follow up visit in 3 weeks
  • Narcotic pain control should be limited by 3 months post op.
  • NO NSAIDs
  • TLSO brace for 3 months.
  • Core Trunk Stabilization should re-start at 2 months in the brace, 2-3 days per week for 6 weeks, followed by a therapist taught home exercise program.
  • Home walking program. Start immediately after surgery. By follow up,patient should be able to walk>l mile per day.
  • Return to work at 6 weeks for sitting type job, or 4 weeks for standingjobs.

Notes:

Back pain is usually moderate (3-6/10) for the first 3 weeks. Adult scoliosis patientsexpect to keep 3/10 level pain for years

Residual numbness in the leg or foot is not uncommon and can last for years.

Anyone who has legpain or weakness they did not have before surgery should be

evaluated immediately and reevaluated with a PE, MRI w/ GAD, andor CTmyelogramSTAT! Do the above and call me. Book the patient into my clinic

within 24hrs for weakness, or 1-7days for pain, with the films completedfor me toreview.

Lumbar Fusion Post Op Protocol

  • (See DISD Clinical Protocol)
  • Follow up visit in 3 weeks
  • Narcotic pain control should be limited by 3 months post op.
  • NO NSAIDs!! ASA ok.
  • LSO brace for 3 months
  • Core Trunk Stabilization should re-start at 2 months in the brace, 2-3 daysper week for 6 weeks, followed by a therapist taught home exerciseprogram.
  • Home walking program. Start immediately after surgery. By follow up,patient should be able to walk >1 mile per day.

Notes:

Back pain is usually moderate (3-6/10) for the first 3 weeks. Adult scoliosis patients expect to keep 3/10 level pain for years

Residual numbness in the leg or foot is not uncommon and can last for years.

Anyone who has leg pain or weakness they did not have before surgery should be

evaluated immediately and reevaluated with a PE, MRI w/ GAD, and or CT myelogram STAT! Do the above and call me. Book the patient into my clinic

within 24hrs for weakness, or 1-7days for pain, with the films completed for me toreview.

Cervical Fusion Post Op Protocol

  • (See DISD Clinical Protocol)
  • Follow up visit in 3 weeks
  • Narcotic pain control should be limited by 8 weeks post op.
  • NoNSAIDs.
  • MiamiJ Cervical Collar for 3-4 weeks, followed by a soft collar for 2 weeks
  • Active range of motion(A-ROM) in the soft collar ok at home.
  • Home walking program. Start immediately after surgery. By follow up, patient should be able to walk >1 mile per day.

Notes:

>90% of patient should have almost complete resolution of arm pain.

Residual numbness in the arm or hand is common and can last for a year.

Anyone who has arm pain or weakness they did not have before surgery should be

evaluated immediately and reevaluated with a PE, MRI w/ GAD, andor CTmyelogramSTAT! Do the above and call me. Book the patient into my clinic

within 24hrs for weakness, or 1-7days for pain, with the films completed for me toreview.

Cervical Laminectomy/Laminoplasty Post Op

Protocol

  • (See DISD Clinical Protocol)
  • Follow up visit in 3 weeks
  • Narcotic pain control should be limited by 8 weeks post op.
  • NSAIDs ok
  • MiamiJ Cervical Collar for 3-4 weeks, followed by a soft collar for 2
  • weeks.
  • Gentile active range of motion(A-ROM) in the soft collar ok at home.
  • Home walking program. Start immediately after surgery. By follow up,patient should be able to walk >1 mile per day.

Notes:

>90% of patient should have almost complete resolution of arm pain.

Residual numbness in the arm or hand is common and can last for a year.

Anyone who has arm pain or weakness they did not have before surgery should be

evaluated immediately and reevaluated with a PE, MRI w/ GAD, and or CT myelogram STAT! Do the above and call me. Book the patient into my clinic

within 24hrs for weakness, or 1-7days for pain, with the films completed for me toreview.

Lumbar Laminectomy Post Op Protocol

  • (See DISD Clinical Protocol)
  • Follow up visit in 3 weeks
  • Narcotic pain control should be limited by 8 weeks post op.
  • NSAIDs may be required long term.
  • Rip Cord Brace for 3 weeks
  • Core Trunk Stabilization should re-start at 3 weeks 2-3 days per week for6 weeks, followed by a therapist taught home exercise program.
  • Home walking program. Start immediately after surgery. By follow up,patient should be able to walk >1 mile per day.

Notes:

>90% of patient should have almost complete resolution of their leg pain or

cramping.

Residual numbness in the leg or foot is common and can last for a year.

Anyone who has leg pain or weakness they did not have before surgery should be

evaluated immediately and reevaluated with a PE, MRl w/ GAD, and/or CTmyelogramSTAT! Do the above and call me. Book the patient into my clinic

within 24hrs for weakness, or 1-7days for pain, with the films completed for me toreview.

Microlumbar Discectomy Post Op Protocol

All Patients except Professional Athletes

  • Follow up visit in 3 weeks
  • Narcotic pain control should be limited by one month post op.
  • NSAIDs may be required long term for back pain(re1ated to arthritis).
  • Rip cord brace for 3 weeks
  • Core Trunk Stabilization should re-start at 2 weeks 2-3 days per week for6 weeks, followed by a therapist taught home program.
  • Home walking program. Start immediately after surgery. By follow up,patient should be able to walk>1 mile per day.

Professional Athletes

  • Follow up visit in 3 weeks
  • Narcotic pain control should be limited by one month post op.
  • NSAIDs may be required long term for back pain (re1ated to arthritis).
  • Rip cord brace for 3 weeks
  • Core Trunk Stabilization should re-start at 1 week 4-5 days per week at the following locations. (Physiotherapy Associates(Bi1tmore or Tempe
  • only), Brett Fisher(Tempe), Pablo Ruiz (Goodyear), Paul Hospenthal(Scottsdale), Monte Hesler ( Anezazi )
  • Ok to return to practice once they have completed a level 3 stabilizationprogram, and then return to full competition once level 5 is maintained.

Notes:

>95% of patient should have almost complete resolution of their leg pain.

Residual numbness in the leg or foot is common and can last for a year.

Weakness if present can take 6 months to improve.

Anyone who has legpain or weakness they did not have before surgery should be

evaluated immediately and reevaluated with a PE, MRI w/ GAD, and/or CTmyelogramSTAT! Do the above and call me. Book the patient into my clinic

within 24hrs for weakness, or 1-7days for pain, with the films completed for me toreview.

Desert Institute for Spine Disorders Physician Assistant ProtocolPage 1 of 4 Revised Sep 21, 2007