A nurse is caring for a client following a lumbar spinal fusion. The client reports sudden onset of severe leg pain and is unable to move their toes. What is the PRIORITY action?

POST-SPINAL SURGERY NEUROLOGICAL DETERIORATION is a surgical emergency. NEW ONSET OF MOTOR DEFICIT (inability to move toes) in a post-laminectomy or spinal fusion patient is NEVER normal — it requires IMMEDIATE assessment and intervention.

Possible causes: EPIDURAL HAEMATOMA — blood collects in the epidural space and compresses the spinal cord; most common cause of post-spinal surgery neurological deficit.

Window for intervention: neurological function can often be preserved if decompressive surgery occurs within 4-6 hours of onset; beyond this window, deficits may become permanent; HARDWARE COMPLICATION — screw or cage malpositioning; OEDEMA — surgical site oedema compressing neural structures.

What not to do: Do NOT administer analgesics and re-assess — the pain and neurological deficit require immediate evaluation, and analgesics may mask the assessment; Do NOT assume it's normal post-operative discomfort — motor deficit is NEVER within normal range post-operatively; Do NOT wait — the speed of surgical decompression determines whether function can be preserved.

Nursing assessment to report: Exact onset time; baseline neurological assessment before surgery (what was normal for this patient?); current motor, sensory, and bowel/bladder function; vital signs; pain characteristics.

After notification: Prepare for emergency imaging (MRI or CT myelogram); possible emergency return to OR.