SCOLIOSIS

SCOLIOSIS
• Lateral curvature of the spine involving rotation of the vertebral bodies

TYPES
• Idiopathic Scoliosis
o No apparent cause – The most common – Genetic disposition (adolescent girls)
• Congenital Scoliosis
o Born with a Vertebral abnormality
o Prognosis variable, depends on client repair because resp.
o Depends on what the defect is
• Paralytic Scoliosis
o Neuromuscular TX – Very complex; a palliative thing to help deal with the
neuromuscular disease along with trying to work with the NM disease
 A child with MD will loose muscle tone throughout their life; they can’t even
hold themselves up; the Harrington rod will be placed to keep back straight
and allows the lings to expand as much as possible.
o As a result of some other type disease
o Seen with neurogenic disease such as CP, MD – tx compiles
o Spine rotates due to loss of muscle control

INCIDENCE
• Most common spinal deformity

CLINICAL MANIFESTATIONS

• Visible curve of the spine (X-Ray)

• Rib hump when the child is bending forward and the ribs are not at an even level
• Asymmetric rib cage
• Uneven shoulder and or pelvic heights
• Difference in the space between the arms and the trunk when standing
• Apparent leg-length discrepancy (Pant/Shirt not hanging evenly)
• In severe cases, usually paralytic types
o They have reduced vital capacity – Complication
• Disproportionately short thorax and long arms
• Assessment at pt. Growth spurt (rare in males) usually around age 9 but 10-
adolensence(15)
• Not usually noted by family members; the parents get adjusted to the unevenness
• Usually a teacher notices a skirt does not hang evenly

DIAGNOSTIC EVALUATION
• Observation
• They are then sent to get an X-ray or radiographic exam to diagnose
o MRI – Determines not a tumor or mass
• Usually screening done around 9-15 years of age
 • Confirm and assist with treatment
• Treatment will be based on degree of curvature
THERAPEUTIC MANAGEMENT
• Long term aimed at maintaining spinal stability. Prevent further progression of deformity
until bone growth is completed.

TREATMENT
o 0-20o
 No treatment recommended
 They will monitor and follow up and make sure it does not become worse
o 20-40o
 A non surgical intervention
 Exercise or walking may be an intervention to decrease curvature
 Following with X rays and using some sort of Brace device
 The Brace depends on situation
 Milwaukee Brace – wear 23 out of 24 hours
 A lot of problems with compliance
 Body Image disturbance
 Brace is not fitted until the child has stopped growing then they will start treating it. It
is very expensive
o >40o
 Surgery; Major Surgery
 Very long and involves every body system
 Will look at this very carefully before having done
 Will be done when their lung capacity if being affected
• Will do a fusion of the vertebra; It will not grow
• The child will not grow any more in height after the fusion
• Usually wait as long as possible before the surgery
o >80o
 Life threatening (Lung and Respiration)

BRACING
o Depends on MD; Wear brace months; May Ambulate with brace

SURGICAL PROCEDURES

o Herrington rods
 Straighten curve with rods / hooks (1 yr fusion takes place)
 Uses bone graft to attach rods or hooks to vertebra
• Logroll
• Flat bed – 7-10 days
• Body Brace / Cast Usually 6 months
 Usually done in the summer so not to miss school
o Spinal fusion
 Will wait as long as possible because this will stop growth.
o Cotrel Dubousset
 (France) Metal rods applied differently with hooking vertebral with increased
movement. No brace post op, up to 2-5 days logroll.

PROGNOSIS
• Excellent Can be prepared to deal with and the person can do fine after the surgery
 • Will be monitored closely with follow up
• The older the child at the time it appears the better the prognosis
• The younger the more severe

NURSING CARE
• A lot of teaching
• Must wear the brace; because if they don’t wear the brace they may have to have surgery
• If they do have the surgery:
o Showing them the equipment; talk about logrolling; talk to a person that has been
through this
• Let them know post op they will have a lot of pain; usually on a PCA pump
• Fluid status: they have lost a lot of fluid; usually a lot of bleeding during the surgery
• Positioning: they have to logroll; cannot get up; catheter or bedpan.
• Respiratory Function: May be painful to breathe
• As patient stabilizes: Mobility increases quickly and diet progresses with GI function
returns.
• Discharged usually on 5th day
o If Harrington rod they may stay longer
• Long term follow up and close monitoring
• Compliance is very important – The surgery may or may not work depending if the parents
bring them in for follow up.

NURSING DIAGNOSIS
• Risk for impaired skin integrity related to wearing of a brace; surgery
• Knowledge deficit related to lack of information about the natural history of scoliosis and
available treatment modalities
• Days after surgery: Body image disturbance related to a postural deformity, to bracing, or
to a surgical scar on back
• Anxiety related to impending surgery; brace
• Risk for injury related to neurovascular deficit secondary to instrumentation (complaint with
post op treatment)
• Pain related to the operative procedure
• Immediate Post OP : Ineffective airway clearance related to long-term anesthesia and
intubation, immobility, and pain associated with spinal fusion; curvature of spine
• Knowledge deficit related to home care following spinal fusion (Increase R/F
noncompliance)

PREOPERATIVE
• Life threatening surgery that will affect every body system
• Tubes (not Foley, IV)
• Teach about long term recovery
• Risk for Increase blood loss
• Possible brace
• ICU Care
• Log Roll
• Painful

DISCHARGE
• Usually 5th postop day
• As stabilize their mobility will increase within a couple of days
• GI Function, then increase diet