Evaluation and Management of Spinal Column Fractures in Adults

• Anatomy of the cervical, thoracic, and lumbar spine is described.
• Fractures involving the odontoid process, vertebral body, pedicles, facet, or lamina require orthopedic or neurosurgical referral.
• Fractures involving the spinous process or transverse process on the thoracic or lumbar spine may be treated by the nurse practitioner.
• Possible cervical spine injury may be evaluated using the Canadian C-spine rule.
• Any abnormal physical exam finding should be further evaluated using a computed tomography scan.

Nurse practitioners working in many settings are faced with the challenge of diagnosing and managing patients with potential or actual spinal column fractures. In this article we provide nurse practitioners with the knowledge necessary to evaluate for and diagnose spinal column fractures in adults. We also provide guidelines for the appropriate management of injuries and identify when referral is recommended.