Nursing care plan disc surgery

I. Pathophysiology—Laminectomy is the surgical excision of
a vertebral posterior arch performed in the presence of a
herniated disc for the purpose of relieving pressure on the
spinal cord nerve roots and removing a source of pain.

II. Types
a. Open laminectomy is performed under general anesthesia;
skin, muscles, and ligaments are cut, bone may be
permanently removed.
i. Procedures include combinations of disc excision, nerve
decompression, and bone fusion—with or without spinal
instrumentation, such as pedicle screws, plates, rods,
fusion cages, bone grafts, or synthetic disc materials.
ii. Client may be in hospital for several days.
b. Minimally invasive procedures, performed under brief general
anesthesia, cause minimal damage to muscles; no bone
is removed, and no large incisions are made.
i. In endoscopic surgery, surgical tools are inserted into a
small incision and the herniated disc is removed or
remodeled.
ii. In percutaneous or endoscopic microdiscectomy, disc
material is removed through a small puncture in the skin,
using a microscope for guidance.
iii. Damaged discs may be replaced with an artificial disc or
interbody cage fusion with the goal of preserving
vertebral height and some flexibility and movement
(Bitan, 2008; Eidelson, 2002).
iv. Several other products are currently being tested in the
United States, including OP-1—a genetically designed
putty—which fuses diseased vertebrae and replaces the
conventional bone graft (Food & Drug Administration
[FDA], 2004).
v. Because of an anticipated short recovery period, client
may go home on day of surgery.

III. Statistics (Gale, 2007)
a. Morbidity: Approximately 450 cases of herniated disc per
100,000 require surgery; 150,000 cases annually in the
United States, with the average age for surgery at 40 to
45 years.
b. Mortality: Rate is between 0.8% and 1%, approximately
1,000 yearly depending on whether a fusion is included
with laminectomy and presence of comorbidities.
c. Cost: Average total cost of a lumbar laminectomy is
$85,000 or over $12 billion annually in hospital charges.

Care Setting
Inpatient or outpatient surgical or orthopedic unit. This plan
of care relates to the open surgical procedures where the
client experiences a hospital stay.

Related Concerns
Psychosocial aspects of care
Surgical intervention

Nursing Priorities
1. Maintain tissue perfusion and neurological function.
2. Promote comfort and healing.
3. Prevent or minimize complications.
4. Assist with return to normal mobility.
5. Provide information about condition, prognosis, treatment
needs, and limitations.

Discharge Goals
1. Neurological function maintained or improved.
2. Complications prevented.
3. Limited mobility achieved with potential for increasing
mobility.
4. Condition, prognosis, therapeutic regimen, and behavior
and lifestyle changes are understood.
5. Plan in place to meet needs after discharge.

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