Role of Physical Therapy preoperative and postoperative spinal

and peripheral spinal transfers

A nerve transfer is a surgical operation in which a surgeon reroutes a healthy,
redundant, functional nerve (donor nerve) to connect to a nonfunctioning, injured
nerve (recipient nerve). This permits donor nerve fibers (axons) to develop through
the recipient nerve. The injured nerve regains its capacity to deliver movement and
sensation impulses to the muscle or patch of skin to which it is connected when the
axons regrow. The purpose of a nerve transfer is to restore muscular function or
skin feeling that has been lost owing to nerve injury.

Role of Physical therapy in Preoperative Phase according to (Tekmyster, et al,

2021)

• Evaluation of the patient's baseline state in pain, functional mobility, and

psychological aspects during the preoperative/preimplantation phase.

• Postoperative precautions and/or contraindications, bed mobility and transfer

training, wound care, general overview and prognosis, and postoperative
rehabilitation process expectations.

• Address any psychological issues. When required, consult with a licensed

psychologist or psychiatrist. When noted, psychologically aware physical
therapists should focus on pain neuroscience education, with an emphasis on
managing fear of movement, fear avoidance, and pain catastrophizing behaviors.
This education may include, but is not limited to, the differences between acute
and chronic pain, how pain becomes chronic, and which variables contribute to
chronic pain (stress, sleep, diet, physical activity, pain cognitions, pain behaviors,
and social involvement).

Role of Physical therapy in Postoperative Phase according to (Tekmyster, et

al, 2021)

During the Immediate Postoperative Phase (days 0–7), physical therapy

management and patient education include:

• precautions and/or contraindications with activities of daily living.

• education on home-based treatment until commencing outpatient PT.

• Start of individualized walking program.

• Education on active recovery of daily activities that promote healing but do not
interfere with surgical site tissue regeneration.

Protective Phase postoperatively (weeks 1–4), what PT role is?

Lumbar and cervical Spine Considerations

• Promote gentle and pain free range of motion within 50% of the normal range.
Encourage hip hinging to no more than 45while bending or squatting.

• Initiation of Home Exercise Program.

• Identify fearful movements and activities

• Lifting guidelines for lumber spine:

1) Maintain a symmetric upright posture.

2) Keep object close to the body.

3) Keep the weight of the object low.

4) Lift symmetrically using both hands.

5) Lift without jerking using a moderate speed.

• Lifting guidelines for cervical:

1) Maintain a symmetric upright posture,

2) Keep object close to the body,

3) Keep the weight of the object low.

4) Lift symmetrically using both hands.

5) Lift without jerking using a moderate speed.

References:

Novak, C. B., & Rebecca, L. (2013). Evidence and techniques in rehabilitation

following nerve injuries. Hand clinics, 29(3), 383-392.

Joaquim, A. F., Makhni, M. C., & Riew, K. D. (2019). Post-operative nerve

injuries after cervical spine surgery. International orthopaedics, 43, 791-795.

Tekmyster, G., Jonely, H., Lee, D. W., Myerson, J., Avery, M., Moradian, M., &
Desai, M. J. (2022). Physical therapy considerations and recommendations for
patients following spinal cord stimulator implant surgery. Neuromodulation:
Technology at the Neural Interface.