Emerging Spine Care Trends and Innovations.

The spine is an anchoring structure that is the base for mechanical motion of the body and a protector of neuroelements. Spinal disorders continue to plague generations with issues. Management options continue to evolve, allowing for operative and nonoperative pathways to treat underlying causes. Positive patient outcomes and long-term relief are achieved through evidence-based practice and innovative trends. The future of spine care will continue to push boundaries, allowing patients to return to activity at a much faster rate, with decreased restrictions and lower rates of future complications.

Evidence-based diagnosis and treatment of cervical spine disorders.

Neck pain from cervical spine disorders is the second-leading cause of musculoskeletal disorders. Neck pain can exist alone or with the presence of upper extremity symptoms. This review of evidence-based guidelines assists the provider in identifying and treating various cervical disorders.

Nurse practitioner-led surgical spine consultation clinic.

AIM: This study is a report of a study of patient satisfaction with non-surgical nurse practitioner management of pre-selected spinal referrals. BACKGROUND: Nurse practitioners are linked to particular patient populations or specific physicians in a medical setting. In a universal healthcare delivery system, patients are often faced with long and anxiety-provoking waiting times, particularly for sub-specialized consultations such as spinal surgery. METHOD: A nurse practitioner-led spine consultation ambulatory clinic was implemented at a Canadian neuroscience centre. A prospective patient satisfaction and clinical accuracy study was performed in 2008. All patients assessed by the nurse practitioner completed a post-consultation validated patient satisfaction questionnaire. All patients were reviewed with the surgeon for confirmation of diagnosis and management. RESULTS: A total of 177 pre-selected patients (disc-herniations, spinal stenosis, degenerative disc disease) were assessed by the nurse practitioner. Mean time from referral to nurse practitioner clinic assessment was 12 weeks (range: 9·8-21 weeks) compared with 10-52 weeks if seen in a conventional clinic. Nurse practitioner clinical diagnosis and management plan were in agreement with those of the surgeon (100% and 95% respectively). Patient satisfaction was 97% with the consultation and 94% and with examination thoroughness. Preference for a longer waiting period for direct consultation with the surgeon was 26%. CONCLUSION: Nurse practitioners can play an effective and efficient role in providing care to patients requiring specific disease management in a specialty setting. The nurse practitioner-run clinic offers accurate and earlier assessment, thus facilitating a timelier diagnosis and management plan.

Elimination of excess preoperative wait time and its impact on immediate clinical outcomes among patients undergoing spinal surgery.

A process improvement initiative reduced the immediate preoperative wait time for patients undergoing spinal surgery by 30 minutes. Data from spinal surgeries occurring before and after the initiative were compared with patients arriving 2 hours vs 1.5 hours prior to surgery, respectively. In this study, we describe the association between reduced preoperative wait time and 3 clinical end points-postoperative pain, use of anxiolytics in the preoperative waiting period, and length of time in surgical recovery. The reduction in preoperative wait time did not compromise clinical outcomes and likely made a positive difference for patients in terms of convenience.

Terapia de la risa. En el dolor crónico músculo-esquelético / Laughter Therapy for chronic skeletal muscular pain

Se explican los efectos de la introducción de talleres de risoterapia y relajación en una unidad de educación terapéutica y rehabilitación funcional, y se comprueba si su aplicación ayuda a disminuir el dolor, mejorar la movilidad y reducir el estado emocional alterado (ansiedad-depresión) del paciente(AU)

The authors explain the effects introducing workshops for laughter therapy and relaxation to a unit dedicated to therapeutic education and functional rehabilitation; the authors test to see if the application of this therapy hepls to decrease pain, to improve mobility and to reduce na altered emotional state, such as anxiety-depression, common among chronic pain patients(AU)

Artificial disc replacement--evolutionary treatment for degenerative disc disease.

Back pain is a common problem that affects the majority of people at some point in their lives. Most back pain is not serious, but back pain caused by injury and aging can result in chronic pain that can last months, years, or indefinitely. Arthrodesis (ie, spinal, fusion) has been the treatment of choice for symptomatic degenerative disc disease that has not responded to conservative treatment modalities. Artificial disc replacement is a more recent option that preserves spinal motion but also recreates the natural function of the disc. The history of artificial disc replacement surgery, preoperative preparation, the surgical procedure, and postoperative recovery are discussed.

Osteogenic sarcoma of the sacral spine: an interdisciplinary team challenge.

A child with osteogenic sarcoma of the sacral spine has complex nursing and interdisciplinary team needs. The course of one patient is discussed, both from the patient and family's perspective and that of her inter-disciplinary care team. The need for a coordinated, holistic approach to care that involves advance planning, continual reassessment of goals, and clear communication among the team members and consulting services is clearly demonstrated.

Thoracoscopic spine surgery: current indications and techniques.

The first report of thoracoscopic surgery was in 1910, after Jacobaeus used thoracoscopy to lyse tuberculous lung adhesions. However, it was not until the end of the century that Lewis (1991) recognized the value of thoracoscopic surgery, and Mack (1993) reported the application of video-assisted thoracic surgery (VATS) for spine surgery. VATS is still in its infancy and the application of this technology for spine surgery continues to rapidly expand. The current indications for thoracoscopic spine surgery include tissue biopsies, thoracic paravertebral abscess drainage and debridement, thoracic disc herniation excisions, anterior spinal release and/or fusion for spinal deformity, stabilization and fusion of thoracic and thoracolumbar fractures, corpectomy for vertebral tumors, and the placement of anterior spinal instrumentation with fusion. This article reviews these current indications for VATS--the technique and subsequent nursing implications.

Epidural abscesses of the spine: case comparisons.

Epidural abscesses of the spine generally arise from staphylococcal infections that by hematologic spread or direct invasion affect the integrity of the vertebral column or meningeal coverings of the spinal cord. A case comparison approach highlights goal-oriented nursing interventions which assist the patient in the adaptation to and recovery from this unique central nervous system infection.