In the era of value-based care and impending bundling of spine care, nurses and nurse practitioners (NPs), are increasingly integral to bridging the gap in providing quality
care for spine patients. This gap in care is caused by an increase in the aging population
and limited access to specialized care. In this article, we will review the importance and
necessity of nurses and NPs in spine practice.
Based on US Census data, the median age of the population will increase over the next
1 With this increasing aging population, the incidence of degenerative spinal
conditions will also grow2 and lead to more patients seeking care for their back or neck
problems. Not only will we see an increase in numbers of patients, but we’ll see an increase in elderly patients specifically. As the population increases, the diagnosis of other
medical comorbidities such as hypertension, high cholesterol, heart disease and diabetes
will also increase. These diagnoses are treatable, but do add another layer of complexity
when treating patients with back and neck pain.
In an effort to expand access to patients, NPs are practicing independently or collaboratively and are able to evaluate the patient at the onset of spine-related symptoms.
Sarro, Rampersaud and Lewis reported on an NP-led surgical spine consultation clinic in
2010.3 The study included 177 pre-selected patients with a diagnosis of disc herniation,
spinal stenosis or disc degeneration. The NP assessed the patient and developed a diagnosis based on clinical symptoms and radiographic findings. Together with the patient,
a treatment plan was developed. A surgeon in the practice then evaluated the patient.
NP and surgeon diagnosis were in agreement 100% and the treatment plan was 95% in
agreement. Patient satisfaction for the NP consultation was 97%, and 94% for examination
thoroughness. In addition to demonstrating NP effectiveness in diagnosis and treatment
of patients suffering from diseases and disorders of the spine, the NP in this particular
Canadian study was also able to provide appointments to patients sooner, an average of
12 weeks versus a 31-week wait for other providers.
The complexity of spine care and treatment options lends itself to a recent concept termed
spine navigation. Navigation is applicable as the condition is longer in duration; has variable symptoms and diagnosis, multiple providers and in various locations; or is poorly
4 This will be especially helpful with the aging population. Nurses are able to
fill the role of spine nurse navigator. Spine conditions have several options for providers
as an entry point to care, and a nurse’s knowledge with spine conditions and providers
will allow the patient to make an informed decision. The navigation process will benefit
patient and providers alike; matching the patient with the best provider at the onset will
decrease frustrations for both.
Six years ago, the Spine Center at Washington University established an NP position
with the intent of capturing the acute/subacute population of spine patients. The typical
wait for a new spine patient prior to this time was three months and those willing to wait
had experienced pain for years. The center is a collaboration between physiatry and or-
Spine Center/Physical Medicine
and Rehabilitation, Washington
St. Louis, MO
University of Texas Southwestern
Expanding Roles for Nurses and Nurse
Practitioners in Spine Care