Questions or comments about this article may be directed to Hilaire Thompson, PhD RN CNRN FAAN, at email@example.com. She is the Immediate Past Editor of American Association of Neuroscience Nurses Clinical Practice Guideline Series.
The author declares no conflicts of interest.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.jnnonline.com).
Thoracolumbar Spine Surgery: A Guide to Preoperative and Postoperative Patient Care
Angela Starkweather, PhD, RN, ACNP-BC, CNRN (chair); Kristy Darnell, RN, MSN, APN, CNRN; Carey Heck, RN, MSN, ACNP-BC, CCRN, CNRN; Karen Merchant, RN, MSN, CNRN; Charlotte S. Myers, RN, MS, APN-C, CNRN; Kristen Smith, RN, MSN, ANP-BC, CNRN
ABSTRACT: Low back pain is the most common cause of disability in persons younger than 45 years of age, and more than 1 million spine procedures are performed annually in the United States. The purpose of the guideline is to help registered nurses, patient care units, and institutions provide safe and effective care to patients who are undergoing thoracolumbar spine surgery across the continuum of care. Included in the guideline are a review of thoracolumbar conditions and the nursing management associated with assessment and diagnostic testing, recommendations for preoperative nursing care, intraoperative nursing care, postoperative nursing care, and clinician, patient, and family resources.
Over 1 million spine surgeries are performed each year in the United States, with fusion procedures accounting for almost one third of these (Katz, 2006). Registered nurses have a critical role during the perioperative period of patients with thoracolumbar disorders in assessing and monitoring neurological status, implementing interventions to enhance healing and recovery, and providing patient and family education to prevent complications and optimize patient outcome and reduce costs of care. The goal of the guidelines is to offer evidence-based recommendations on nursing activities that have the potential to maximize patient outcomes for persons undergoing thoracolumbar spinal surgery. This document represents a revision of a guideline for care of the patient undergoing lumbar spine surgery first published in 2006 and now has been expanded to include thoracic issues.
The guideline sought to address the following clinical questions:
* What are the anatomical and pathophysiological processes leading to spine disorders?
* Which surgical procedures are typically used for each specific thoracolumbar spine disorder?
* What are the nursing responsibilities in the assessment, planning, and coordination of care for the patient undergoing thoracolumbar surgery?
* What are the nursing implications of diagnostic studies?
* What nursing interventions related to preoperative planning, intraoperative positioning, pain management, infection control, deep vein thrombosis prophylaxis, wound care, bladder/bowel management, bracing, nutrition, physical functioning, and rehabilitation needs should be used to enhance optimal outcomes and decrease complications?
* What resources are available to clinicians, patients, and families for preoperative and postoperative care?
In the development of the guideline, a computerized search of Medline, Cochrane, and the Cumulative Index to Nursing and Allied Health Literature was performed using the names of specific nursing interventions with particular spine pathologies and surgery as keywords. The search was restricted to works in English published in 2000–2011 in which the sample included patients with thoracic and/or lumbar spine disorders. A panel of nursing experts developed recommendations for practice based upon the quality of available supporting evidence. The guideline includes a review of thoracic and lumbar spine anatomy and the care of persons with various thoracolumbar conditions, including herniated nucleus pulposus, degenerative disc disease, stenosis and spondylosis, spondylolisthesis and spondylolysis, scoliosis and kyphosis, fractures of the thoracolumbar spine, and cauda equina syndrome. The guideline includes specific recommendations for nursing assessment, management activities related to diagnostic testing, as well as recommendations for preoperative, intraoperative, and postoperative nursing care. Included in the guideline are resources for clinicians as well as patients and family members. The complete guideline is available as Supplemental Digital Content, at http://links.lww.com/JNN/A5.
Katz J. N. (2006). Lumbar disc disorders and low-back pain: Socioeconomic factors and consequences. Journal of Bone and Joint Surgery, 88 (Suppl. 2), 21–24.