What to glean from Neurosurgery

[MSKalltheway]

I'm doing a Neurosurgery rotation and was wondering what you all think is important to take away from it in terms of management from a PM&R standpoint. Things like what to expect from neurosurg pts coming to rehab, post-op care on an outpt basis, or anything else you'd like to ask about if you had a minute with a neurosurgeon sitting right in front of you.

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[RUOkie]

I'm doing a Neurosurgery rotation and was wondering what you all think is important to take away from it in terms of management from a PM&R standpoint. Things like what to expect from neurosurg pts coming to rehab, post-op care on an outpt basis, or anything else you'd like to ask about if you had a minute with a neurosurgeon sitting right in front of you.

The post op stuff/rehab stuff is easy. Go into management. Find out WHY they believe in fusion for stable Grade I spondylolisthesis. Challenge them to discuss discogenic pain, disc arthoplasty etc. Discuss the workup for NPH (ie, how do you properly read/order a cisternogram) Cause these are the things you will be seeing in your clinic. Your patiets will challenge you as to why you may be treating things differently than the surgeons. If you know how they think, you can discuss things honestly.

Go into it with an open mind and try to think like a surgeon. Then once your rotation is done, you can challenge those practice techniques with knowledge.

My best friend is a neurosurgeon. We cotreat a lot of patients. He no longer fuses discogenic pain. Why? I also send him some surgical cases earlier than I would of just post residency. Some radiculopathy and spinal stenosis you know are not going to do well with conservative management.

 

[oreosandsake]

not to thread jack from MSKalltheway but a question along the same lines...

if a PM&R hopeful only had one month to do either an ortho rotation, or a neurosurg rotation, what would be recommended?

 

[Ludicolo]

not to thread jack from MSKalltheway but a question along the same lines...

if a PM&R hopeful only had one month to do either an ortho rotation, or a neurosurg rotation, what would be recommended?

Dude, you’re a fourth year. What are you doing signing up for surgical rotations?

 

[oreosandsake]

Dude, you’re a fourth year. What are you doing signing up for surgical rotations?

LOL, a glutton for punishment? j/k

i have some elective time in my TY and there's a (slim ) chance that I will broaden my education by doing a month of either ortho or nsg.

 

[MSKalltheway]

Dude, you’re a fourth year. What are you doing signing up for surgical rotations?

Lol that's basically the reaction I got from Dr. Massagli when I went to UW. She looked at me like I had three heads when I told her, and had to promise it was actually not a demanding rotation

 

[Llenroc]

Well if you don't like surgery, there's a lot of PM&R programs out there that will put you through difficult surgery months: San Antonio, Cincinnati, etc.

But yeah, you're right, I wouldn't go out of my way to do that stuff my 4th year as a student.

 

[bedrock]

LOL, a glutton for punishment? j/k

i have some elective time in my TY and there's a (slim ) chance that I will broaden my education by doing a month of either ortho or nsg.

It depends on the institution, but many times you can set up a month of outpatient only NS or ortho. It's more high yield, less hours, and you can still learn quite a bit. I did both during my transitional year and it gave me a heads up on my fellow PM&R residents who had no idea how to do an efficient MSK exam, the basics of reading ortho/spine films, or how to do simple blind joint injections.

 

[topwise]

It depends on the institution, but many times you can set up a month of outpatient only NS or ortho. It's more high yield, less hours, and you can still learn quite a bit. I did both during my transitional year and it gave me a heads up on my fellow PM&R residents who had no idea how to do an efficient MSK exam, the basics of reading ortho/spine films, or how to do simple blind joint injections.

Yeah, I agree with that. If you do all clinic and no surgery, that's higher yield for you.

But in answer to the question of NSG vs. ortho, I'd say pick ortho. But I think you can get the best of both worlds if you can work with an orthopod who also does a lot of spine surgeries. I worked with one of those guys during residency.

 

[RUOkie]

Yeah, I agree with that. If you do all clinic and no surgery, that's higher yield for you.

But in answer to the question of NSG vs. ortho, I'd say pick ortho. But I think you can get the best of both worlds if you can work with an orthopod who also does a lot of spine surgeries. I worked with one of those guys during residency.

+1 or a real sports med orthopod to learn shoulder mechanics. Nothing like an arthroscopy to learn you some anatomy!