Lumbar spine: common pathology and interventions.
Lumbar herniated nucleus pulposus (HNP) and lumbar spinal stenosis (LSS) are common spine pathologies with different clinical presentations and interventions. HNP generally has an acute onset often without a precipitating event. Unless there is a significant or emergent neurologic deficit, nonsurgical medical management is warranted for 6 or more weeks after the onset of symptoms. If there is no improvement in 6 weeks, surgical intervention may be indicated. Microdiscectomy is the gold standard treatment for uncomplicated HNP. LSS has an insidious onset. Often, clinical presentation is a long history of intermittent back pain and gradual decrease in ambulation due to leg pain-which quickly subsides upon sitting. Medical management is the first treatment choice. If there is no improvement in the patient's condition, surgery may be necessary. As with any spine surgery, patient symptoms, clinical exam, and diagnostics must correlate. Postoperative care differs for microdiscectomy and decompressive laminectomy because the surgical pathology and interventions are different. The usual age variation of patients undergoing either of the two procedures will also change postoperative care needs. Neuroscience nurses provide ongoing patient education, and ensure a complete understanding of the proposed surgical intervention and outcome that may be expected by the patient and family. Congruent expectations between the patient and provider are vital. In addition, accurate assessment and evaluation of the patient's physical and functional progress by neuroscience nurses is of the utmost importance.
Strayer
Andrea
A
Dept. of Neurosurgery, UWHC, 600 Highland Avenue, Madison, WI 53792, USA. strayer@neurosurg.wisc.edu
D000208:Acute Disease; D018450:Disease Progression; D017586:Diskectomy; D006801:Humans; D007258:Informed Consent; D007405:Intervertebral Disc Displacement / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D007796:Laminectomy; D017116:Low Back Pain / Q000209:etiology; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D008297:Male; D008487:Medical History Taking; D008866:Microsurgery; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009460:Neurologic Examination; D009722:Nurse Practitioners / Q000458:organization & administration; D024802:Nurse's Role; D009730:Nursing Assessment; D010351:Patient Discharge; D018579:Patient Selection; D019990:Perioperative Care / Q000379:methods / Q000451:nursing; D015985:Precipitating Factors; D013130:Spinal Stenosis / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*