AANN Core Curriculum, 7th Edition, Ch. 22 Spine Disorders: Digital Version-Chapter 22

Chapter 22

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This chapter reviews common spinal disorders, their assessment, treatment, and nursing care. Atlantoaxial instability may result from rheumatoid arthritis, Down syndrome, or trauma; it can compress the spinal cord or vertebral arteries. Imaging includes dynamic radiographs, CT, and MRI. Severe compression may require decompression and fusion.<br /><br />Degenerative cervical and lumbar disease includes disk herniation, spondylosis, and spinal stenosis. Symptoms range from localized pain and radiculopathy to myelopathy, weakness, gait impairment, and bowel or bladder dysfunction. MRI is generally the preferred test for neural compression. Initial care is usually conservative—activity modification, medication, physical therapy, and selected injections—with surgery considered for acute or progressive neurological deficits or persistent disabling symptoms. Lumbar stenosis often causes walking-related leg symptoms relieved by rest and forward flexion; decompression, sometimes with fusion, aims to relieve neural pressure while maintaining stability.<br /><br />Other conditions include thoracic disk herniation, vertebral compression fractures, spondylolysis and spondylolisthesis, ankylosing spondylitis, scoliosis, and spinal infection. Treatment varies from rehabilitation, bracing, and osteoporosis management to surgery. Infection requires cultures, MRI, and prolonged antibiotics; epidural abscess with cord compression is an emergency. Cauda equina syndrome—especially urinary retention, saddle anesthesia, bilateral leg symptoms, or bowel dysfunction—requires urgent assessment and surgical decompression.<br /><br />For nonspecific low back pain, routine early imaging and bed rest are discouraged. Education, continued activity, exercise, weight management, smoking cessation, and appropriate short-term symptom relief are emphasized; red flags warrant investigation.<br /><br />Nursing priorities include monitoring neurological status, pain, wounds, respiratory function, mobility, and circulation; promoting early mobilization and pulmonary hygiene; preventing skin injury; and providing clear recovery instructions. New or worsening weakness, sensory loss, gait problems, or bowel or bladder changes require prompt reporting.

Keywords

spinal disorders

atlantoaxial instability

cervical and lumbar disease

disk herniation

spinal stenosis

myelopathy

MRI

cauda equina syndrome

spinal infection

nursing care