Lumbar Spine: Common Pathology and Interventions
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.
The radicular pain symptomatology associated with lumbar herniated nucleus pulposus (HNP) can be excruciating. For most, 4 weeks after symptom onset, pain control has been achieved and usual activities can be resumed. Approximately 16% of patients are still symptomatic 7 weeks after symptom onset (Rosomoff & Rosomoff, 1999).
Lumbar spinal stenosis (LSS) is the narrowing of the central canal and, often, the lateral recess due to facet joint hypertrophy, thickening and bulging of the ligamentum flavum, bulging of an intervertebral disc, osteophyte formation, or spondylolisthesis. Symptoms include leg and buttock pain with activity that is alleviated by rest or maneuvers that increase spinal canal dimension, such as stooping forward to walk.
These common lumbar pathologies are quite different. Therefore, neuroscience nurses need a basic knowledge of HNP and LSS and the differences in clinical presentation and neurosurgical management of each to ensure they provide optimal care and counsel. This article describes HNP and LSS, presenting signs and symptoms, operative treatment, and nursing care. A brief overview of lumbar functional anatomy is presented.
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.
The radicular pain symptomatology associated with lumbar herniated nucleus pulposus (HNP) can be excruciating. For most, 4 weeks after symptom onset, pain control has been achieved and usual activities can be resumed. Approximately 16% of patients are still symptomatic 7 weeks after symptom onset (Rosomoff & Rosomoff, 1999).
Lumbar spinal stenosis (LSS) is the narrowing of the central canal and, often, the lateral recess due to facet joint hypertrophy, thickening and bulging of the ligamentum flavum, bulging of an intervertebral disc, osteophyte formation, or spondylolisthesis. Symptoms include leg and buttock pain with activity that is alleviated by rest or maneuvers that increase spinal canal dimension, such as stooping forward to walk.
These common lumbar pathologies are quite different. Therefore, neuroscience nurses need a basic knowledge of HNP and LSS and the differences in clinical presentation and neurosurgical management of each to ensure they provide optimal care and counsel. This article describes HNP and LSS, presenting signs and symptoms, operative treatment, and nursing care. A brief overview of lumbar functional anatomy is presented.
