Learning Objectives
By the end of this section, you will be able to:
- Discuss the pathophysiology, risk factors, and clinical manifestations for low back pain and spinal tumors
- Describe the diagnostics and laboratory values for low back pain and spinal tumors
- Apply nursing concepts and plan associated nursing care for the patient with low back pain and spinal tumors
- Evaluate the efficacy of nursing care for the patient with low back pain and spinal tumors
- Describe the medical therapies that apply to the care of low back pain and spinal tumors
Diseases or injuries that affect the spinal cord and back are known as spinal disorders. Spinal disorders include a variety of conditions that cause problems for patients, including pain. This section will cover two spinal disorders, low back pain and spinal tumors. One reason spinal issues are so serious is that every part of the body except the face is innervated by spinal nerves that travel through the spinal cord. The area innervated by a single spinal nerve is called a dermatome. So, when the spinal cord experiences disorder, it can affect almost all of the body (Figure 17.9).
Low Back Pain
Any feeling of aching, burning, or stabbing in the muscles of the lower back is referred to as low back pain. It may include sensations of shooting pains, and the pain may travel down the leg. Low back pain affects the lumbar spine, the five vertebrae that comprise the lower section of the spine found between the body’s ribs and pelvis (Figure 17.10).
Low back pain is a common disorder experienced by an estimated 75 to 80 percent of Americans at least once during their lifetimes. In about 90 percent of cases, low back pain is a temporary problem that can be treated without surgery (AANS, 2024). But for about 50 percent of these patients, low back pain recurs. When low back pain lasts longer than twelve weeks, it is considered a chronic condition (AANS, 2024).
Pathophysiology
Low back pain is caused by a variety of factors that vary among patients. Common causes include injuries, strains, and sprains. Other causes include the following:
- herniated disk—A disk in the spine is compressed, irritating nearby nerves.
- lumbar spinal stenosis—The spinal cord narrows in the lower back, putting pressure on the nerves.
- osteoarthritis—Inflammation in the joints that can occur in the spine.
- osteoporosis—Skeletal disorder that causes bones to lose mass and become at greater risk for fracture.
- axial spondyloarthritis—Inflammatory disease that affects the spine.
- sciatica—The sciatic nerve in the lower back is compressed by a bone spur or herniated disk.
- scoliosis—Condition that causes the spine to curve sideways.
- spondylolisthesis—A vertebra slips out of place in the spine.
Low back pain has three classifications: acute back pain, which occurs suddenly and typically lasts for a few days to a few weeks; subacute back pain, which may occur suddenly, but can also appear gradually, and usually lasts for at least four but no longer than twelve weeks; and chronic back pain, which can appear suddenly or gradually, occurs daily, and lasts more than twelve weeks (National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2023).
Some patients are at greater risk for low back pain. Risk factors include obesity, lack of exercise, and using improper techniques for lifting. Age can be a factor, with older people generally experiencing more low back pain compared to younger people. Smoking and psychological conditions, such as anxiety and depression, have been linked to low back pain. Some diseases, such as arthritis, may cause low back pain (Mayo Clinic, 2023d).
Link to Learning
Nurses are at risk of developing low back pain due to lifting patients as part of nursing care. To avoid developing lower back problems, nurses must learn proper lifting techniques of their patients.
Clinical Manifestations
Low back pain symptoms can vary by patient. Some patients experience localized pain in a certain area, whereas other patients have a more generalized pain that spreads across the back. The pain may also radiate to other parts of the body, including the legs or abdomen. Some patients experience mild low back pain whereas for others, the pain can be intense. Symptoms typical of low back pain include the following:
- pain that comes and goes, becoming worse with activities such as sitting too long, bending, and lifting
- decreased range of motion and/or flexibility, which may include difficulty with standing straight
- weakness, numbness, and/or tingling in legs and/or feet
- bowel and/or bladder issues
- fever
- unexplained weight loss
Assessment and Diagnostics
To assess and diagnose low back pain, patients should undergo a physical examination that includes a review of their medical history and gathers information about the nature of their pain. This includes details about when the pain started, the nature of the pain, and the area(s) of the body affected with pain. The physical examination should check the patient’s muscle strength and reflexes, and the spine should be examined to check for issues such as bone structure changes.
Diagnostics and Laboratory Values
Testing options include x-rays, imaging such as MRIs and CTs, electrophysiological tests, bone scans, discography, nerve conduction studies, and blood tests.
- X-rays may show fractures or breaks in the spine or spinal alignment issues.
- Imaging, such as MRIs and CTs, may show issues such as herniated disks or issues in the spine, nerves, muscles, tendons, tissues, ligaments, and blood vessels that can cause low back pain.
- Electrophysiological tests may show poor electrical activity in the muscles and nerves.
- Bone scans may show fractures and/or infections that have affected the spine.
- Discography may identify disks that are the source of the low back pain.
- Nerve conduction studies measure the nerves’ electrical impulses and show muscle responses. If the nerves are not functioning appropriately, this may indicate the nerves are affected by a problem such as a herniated disk.
- Blood tests identify issues, such as infections, that may contribute to low back pain.
Nursing Care of the Patient with Low Back Pain
Nursing care for patients with low back pain should focus on finding the cause of the pain and treating that cause with the goal of relieving the back pain. For patients who have chronic back pain that cannot be relieved by treating the cause, nursing care should focus on helping patients control and manage the pain.
Recognizing Cues and Analyzing Cues
The cues of low back pain will be found in the patient’s physical examination and test results. Information provided by patients with details about the nature and duration of the pain, as well as findings during the physical examination, such as muscle weakness and reflex issues, will provide additional cues.
Test results should provide cues to confirm the diagnosis. If applicable, cues such as herniated disks, fractures, poor nerve functioning, and infections should be revealed in x-rays and other test results.
Prioritizing Hypotheses, Generating Solutions, and Taking Action
Low back pain should be prioritized based on the severity of symptoms. The nursing interventions appropriate for patients with low back pain may be those in Table 17.20.
| Nursing Care | Rationale |
|---|---|
| Complete focused neurological assessments. | Patients may experience varying levels of pain, decreased range of motion, numbness and/or tingling in their hands and/or feet, and bowel and/or bladder issues. |
| Monitor vital signs. | Changes in the patient’s vital signs, such as heart rate and blood pressure, and fever may indicate health issues. |
| Administer medications. | Low back pain may be treated with medications including pain relievers such as naproxen sodium and anti-inflammatory drugs, topical pain relievers, muscle relaxants, and antidepressants such as amitriptyline and duloxetine. For patients with more severe pain, narcotics such as opioids may be helpful if their use is limited. |
| Provide care before and after surgery. | Some patients may require surgery to relieve their low back pain. Surgical options may include procedures to repair herniated disks and create more space in the spine. Some patients may benefit by having nerve stimulators implanted under the skin to deliver electrical impulses to nerves, blocking pain signals. Nurses help patients prepare for surgery and provide surgical aftercare, such as dressing a patient’s wound(s). |
| Assist with other procedures. | In addition to medication and surgery, some patients may benefit from cortisone injections, which can relieve inflammation and provide pain relief for a few weeks. Other patients may benefit from radiofrequency ablation, which involves using a needle to damage the nerves that are sending pain signals and stop these signals from reaching the brain. Nurses can assist with these procedures by providing care such as giving injections and ensuring that patients are positioned properly for treatment. |
| Coordinate with physical therapist. | Physical therapy can help patients with low back pain learn exercises and techniques to strengthen their muscles, maintain a greater range of motion, and improve their posture, which can help with low back pain. Physical therapists can also teach patients with low back pain how to modify their movements to put less strain and motion on the lower back. |
| Coordinate to arrange mental health support. | Patients who have chronic low back pain may need help coordinating a consultation with a mental health professional to help them cope with the challenges of living with pain. Some patients may need prescription medications to help with issues such as anxiety and depression. |
Evaluation of Nursing Care for the Patient with Low Back Pain
The desired outcome for patients with low back pain is to identify the cause of their symptoms and relieve their pain. If their low back pain is chronic, the desired outcome is to help them control and manage their symptoms.
Medical Therapies and Related Care
The medical therapies used to treat low back pain may be those in Table 17.21.
| Medical Therapy | Explanation of Care |
|---|---|
| Medications | May include pain relievers such as naproxen sodium and anti-inflammatory drugs, topical pain relievers, muscle relaxants, and antidepressants such as amitriptyline and duloxetine. In some cases, narcotics such as opioids may be helpful if use is limited. |
| Surgery | Surgical options may include procedures to
|
| Other procedures | May include cortisone injections and radiofrequency ablation. |
| Physical therapy | May focus on exercises and techniques to strengthen muscles, maintain a greater range of motion, improve posture, and modify movements to put less strain and motion on the lower back. Coordinate with the physical therapist as needed. |
| Mental health support | May focus on helping patients cope with the challenges of living with pain. May include prescription medications to help issues such as anxiety and depression. |
Link to Learning
Some patients with low back pain caused by growths may benefit from radiofrequency ablation (RFA). A minimally invasive procedure called RFA relies on radiofrequency waves to shrink growths, such as tumors or nodules, that cause chronic pain.
Spinal Tumors
A growth of abnormal tissue inside or encompassing the spinal column or the spinal cord is called a spinal tumor. Like other tumors, spinal tumors can be benign (noncancerous) as well as malignant (cancerous). When a spinal tumor originates in the spine or spinal cord, it is considered a primary spinal tumor. When it originates elsewhere in the body and spreads to the spine, it is considered a secondary spinal tumor, or a metastatic spinal tumor.
Pathophysiology
The cause of spinal tumors is unknown. Some of the factors that may create a risk for spinal tumors include defective genes, exposure to toxins, and a compromised immune system. Spinal tumors are also linked to Von Hippel-Lindau disease and neurofibromatosis 2, genetic disorders that can cause tumors throughout the body, including the spine.
Spinal tumors are classified according to the area of the spine where they are located—cervical, thoracic, lumbar, and sacrum—as well as their position within the spinal column (Figure 17.11). These positions include the following:
- intradural-extramedullary—Tumors are located on the inside of the dura, which is the spinal cord’s thin covering, but remain outside the actual spinal cord.
- intramedullary—Tumors are located on the inside of the spinal cord.
- extradural—Tumors are located outside both the dura and the spinal cord.
Clinical Manifestations
The symptoms of spinal tumors vary by patient and by the tumor’s progression. Typical symptoms include the following:
- localized pain at the site of the tumor
- low back pain that may radiate to other areas of the body
- muscle weakness that may spread throughout the body
- stiff back or neck
- difficulty walking
- paralysis in any part of the body as a result of compressed nerves
- loss of sensitivity to pain, cold, and heat
- loss of bladder and/or bowel functioning
Assessment and Diagnostics
Spinal tumors are uncommon, comprising about 15 to 20 percent of central nervous system tumors. Of 100,000 people, 0.5 to 2.5 are predicted to develop a spinal tumor, which makes the lifetime risk less than one percent for developing a malignant spinal tumor (Yale Medicine, n.d.). The symptoms of spinal tumors may resemble symptoms of other diseases and conditions, such as low back pain. To assess and diagnose a spinal tumor, patients should undergo a physical examination that gathers information such as the nature and location of the pain, as well as details of other symptoms, such as difficulty walking and loss of sensitivity to pain, cold, and heat.
Diagnostics and Laboratory Values
X-rays, CT scans, and MRIs may show images of the tumor. If a tumor is found, a biopsy will test a sample of the tissue where the tumor is located and determine if the tumor is cancerous.
Nursing Care of the Patient with Spinal Tumors
Health care for patients with spinal tumors should focus on nursing care before and after the provider removes the tumor and curing the patient if possible. Postoperative nursing care for patients should focus on prevention of infections, as well as ensuring the patient stays immobile without bending, lifting, or twisting the spine. To examine patients and move them as necessary, nurses should rely on the log roll maneuver, rolling the patient in 90-degree steps. Nurses should also note any changes in the patient’s sensations.
If the tumor cannot be removed but it is benign, nursing care should focus on helping the patient learn to cope with the condition. If the tumor cannot be removed and it is malignant, nursing care should focus on treating the cancer as well as possible and, if necessary, helping the patient prepare for the end of life.
Recognizing Cues and Analyzing Cues
The cues of spinal tumors will be observed in the patient’s physical examination, which will show symptoms such as low back pain, mobility difficulty, and bowel and bladder issues. Other objective cues will be found in the patient’s test results, which will show if the patient has a tumor and if so, whether that tumor is benign or malignant.
Prioritizing Hypotheses, Generating Solutions, and Taking Action
Spinal tumor interventions should be prioritized based on the severity of symptoms and whether the tumor is benign or malignant. The nursing interventions appropriate for patients with spinal tumors may include those in Table 17.22.
| Nursing Care | Rationale |
|---|---|
| Complete focused neurological assessments. | The patient’s pain levels, range of motion, symptoms such as difficulty walking, and loss of sensitivity may indicate a spinal tumor. |
| Monitor vital signs. | Changes in the patient’s vital signs such as heart rate and blood pressure may indicate health issues. |
| Provide care before and after surgery. | Some patients with a spinal tumor can be helped with surgery. Nurses should prepare patients for surgery and provide care after surgery, such as dressing patients’ wound(s). |
| Assist with radiation therapy. | Patients may need radiation therapy, which may include side effects such as nausea. Nurses should help patients prepare for radiation therapy and provide care afterward, such as administering medications to deal with side effects such as nausea. |
| Assist with chemotherapy. | Patients may need chemotherapy, which may include side effects, such as nausea and fatigue. |
| Administer medications. | Patients may need medication to help with pain relief, as well as other problems, such as inflammation. |
Evaluation of Nursing Care for the Patient with Spinal Tumors
The desired outcome for patients with a spinal tumor is removal of the tumor. If their tumor cannot be removed, the desired outcome and goal of nursing is to help patients learn to live with the tumor, controlling the symptoms and problems caused by the tumor as much as possible. This includes helping patients learn to control the pain and improve their quality of life with interventions such as better nutrition and exercise. To evaluate the effectiveness of these interventions, nurses can assess patients’ functioning with ADLs. For patients whose tumor causes a terminal condition, end-of-life preparation and care may be needed.
Medical Therapies and Related Care
The medical therapies used to treat patients with spinal tumors may include surgery, radiation therapy, chemotherapy, and medications, such as corticosteroids, which can help reduce inflammation.