Scoliosis, Lordosis, and

Kyphosis
Andi, Deswan, Widi, and Michelle

Scoliosis

Definition
Scoliosis

is a condition in
which the spine bends to side
abnormally; either to the right
or left. The curvature can be
moderate or severe. Any part
of the spine can be bent in
scoliosis; but the most common
regions are the chest area
(thoracic scoliosis) or the lower

According to the National

Health Service (NHS), UK,
in 80% cases there is no
known cause it is
idiopathic.

When scoliosis occurs, the spine can

curve in one of three ways:
The spine curves to the side as a
single curve to the left (shaped like
the letter C), called levoscoliosis.
The spine curves to the side as a
single curve to the right (shaped like
a
backwards
letter
C),
called
dextroscoliosis.
The spine has two curves (shaped
like the letter S).

Other Types of Scoliosis

The most commonly known type of scoliosis isidiopathic
scoliosis.Other types of scoliosis include:
Congenital scoliosis, which developsin uteroand is
present in infancy. A rare condition, affecting one in
10,000, there is no known cause, but in most cases the
spinal curve must be corrected surgically.
Neuromuscular scoliosis, which sometimes develops
in individuals who cannot walk due to a neuromuscular
condition such as muscular dystrophy or cerebral palsy.
This may also be called myopathic scoliosis.
Degenerative scoliosis(adult scoliosis), which is a
common condition that occurs later in life as the joints in
the spine degenerate. Read more aboutadult scoliosis.

Rarely, scoliosis is caused by spinal lesion

or tumor. Patients who are usually younger

(age 8 to 11) than typical scoliosis patients
will experience symptoms such as pain,
numbness and a left-curving thoracic spine
(levoscoliosis). A physician who sees any or
a combination of these symptoms will order
additional diagnostic tests, such as an MRI,
to rule out the possibility of spinal tumoror
other lesions as a cause of scoliosis.

Etiology
Idiopathic scoliosis exact etiology is unknown. Accounts for

65% of cases. Possible causes include genetic factors,

vertebral growth abnormality. Classified into three groups
based on age at time of diagnosis.
Infantile birth to age 3.
Juvenile presentation between age 11 and 17.

Congenital scoliosis exact etiology unknown; represented as

malformation of one or more vertebral bodies that results in

asymmetric growth.
Type I failure of vertebral body formation e.g. isolated hemivertebra,

wedged vertebra, multiple wedged vertebrae, and multiple

hemivertebrae.
Type II failure of segmentation e.g. unilateral unsegmented bar,
bilateral block vertebra.
Commonly associated with other congenital anomalies.

Paralytic or musculoskeletal scoliosis

develops
several
months
after
symmetrical paralysis of the trunk
muscles from polio, cerebral palsy, or
muscular dystrophy.
Neuromascular scoliosis child has a
definite neuromascular condition that
directly contributes to the deformity.
Additional but less common causes of
scoliosis are osteopathic conditions,
such as fractures, bone disease,
arthritic conditions, and infections.

Miscellaneous

factors that can

cause scoliosis include spinal
irradiation,
endocrine
disoders,
postthoracotomy, and nerve root
irritation.
As
the deformity progresses,
changes in the thoracic cage
increase.
Respiratory
and
cardiovascular compromise can
occur
in
cases
of
severe
progression.

Signs and Symptoms of

Scoliosis
Without anX-ray of the spine, there are several common
physical symptoms that may indicate scoliosis. One of the most
common tests for detecting scoliosis is called the Adam's Forward
Bend Test, in which the individual bends from the waist as if
touching the toes. The medical professional then observes for one
or more of the following signs of scoliosis:
One shoulder is higher than the other
One shoulder blade sticks out more than the other
One side of the rib cage appears higher than the other
One hip appears higher or more prominent than the other
The waist appears uneven
The body tilts to one side
One leg may appear shorter than the other
Any type of back pain is not usually considered a scoliosis
symptom.

Diagnostic Evaluation
X-ray

of the spine in the upright position,

preferably on one long 36-inch cassette, show
characteristic curvature.
MRI, Myelograms, or CT scan with three
dimensional reconstruction may be indicated for
children with severe curvatures who have a
known or suspected spinal column anomaly,
before management decisions are made.
Pulmonary function tests for compromised
respiratory status.
Evaluate for renal abnormalities in children with
congenital scoliosis.

Treatment
Scoliosis treatment decisions are primarily based on two
factors:
Theskeletal maturity of the patient(or rather, how much more
growth can be expected)
Thedegree of spinal curvature.
Although the cause of idiopathic scoliosis is unknown, the way
scoliosis curvesbehave is well understood. In essence:
A small degree of curvature in a patient nearing skeletal maturity
is not likely to need treatment;
Conversely, a younger patient with a bigger curve is likely to have
a curve will continue to advance and will need treatment.
There are three main scoliosis treatment options for adolescents:
Observation
Back braces
Scoliosis surgery

Lordosis

Definition
Lordosis is a condition where there is an

increased inner curvature of the spine.

The spine has a natural curve which is
very mild and it helps the spine in its
proper function. This natural curve is
formed due to the shape of the individual
vertebrae that make up the spine. If this
spinal curvature increases, then it puts a
lot of pressure or strain on the other
regions of the spine resulting in pain.

Etiology
There is a syndrome called as the lower
crossed syndrome in which muscles
surrounding the hip and the spine become
tense or weak along with getting
stretched.
All these different conditions of muscles
such as tight and weak muscles result in
muscular imbalance. The muscles which
are usually tight are: Trunk extensors, hip
flexors (especially the iliopsoas muscle)
and these tense muscles need stretching.

The muscles which are usually

weak and stretched are:
abdominal
muscles (rectus
abdominis, internal oblique and
external oblique), and
hip extensors (hamstrings and
gluteus maximus).

Signs and Symptoms

Kyphosis

Definition
The word "kyphosis" describes a type of curve in the

spine. A kyphotic curve is normally present in the

thoracic spine (the part of the spine in the chest area).
A kyphotic curve looks like the letter "C" with the
opening of the C pointing towards the front. Though the
thoracic spine is supposed to be curved, if the curve in a
person's thoracic spine is more than 40 to 45 degrees, it
is considered abnormal - or a spinal deformity.
Adult kyphosis can have varying symptoms and degrees
of severity, from minor changes in the shape of your
back, to severe deformity, nerve problems, and chronic
pain. Kyphosis is most common in the thoracic spine,
though it can also affect the cervical and lumbar spine.

Etiology
Many potential causes of kyphosis have been described.

Scheuermann disease and postural round back are often

identified in adolescents.
Congenital abnormalities, such as failure of formation or
failure of segmentation of the spinal elements, can cause a
pathologic kyphosis.
Autoimmune arthropathy, such as ankylosing spondylitis, can
cause rigid kyphosis to develop as the spinal elements
coalesce.
Kyphosis can also develop as a result of trauma, a spinal
tumor, or an infection. Iatrogenic causes of kyphosis include
the effects of laminectomy and irradiation, which lead to
incompetence of the anterior or posterior column.
Finally, metabolic disorders and dwarfing conditions can lead
to kyphosis.

Pathophysiology
The pathophysiology of kyphosis depends on the etiologic

factor. The exact cause of Scheuermann disease is still

imprecisely defined. Scheuermann postulated that the
condition resulted from avascular necrosis of the
apophyseal ring. Other theories include histologic
abnormalities at the endplate, osteoporosis, and mechanical
factors that affect spinal growth. A Danish study
demonstrated an important genetic component to the
entity.[9]
Postural kyphosis is present when accentuated kyphosis is
observed without the characteristic 5 of wedging over 3
consecutive vertebral segments that defines Scheuermann
kyphosis. This is felt to be due to muscular imbalance
leading to the round-back appearance of these individuals.

When focal kyphosis occurs after a fracture,

more height is lost in the anterior aspect

than in the posterior aspect; this is the
typical fracture pattern. The angulation can
increase as the fracture heals, placing
pressure on the spinal cord. Patients with
fractures have historically been treated
with laminectomy alone, especially in the
thoracic spine, and they often had
progressive kyphosis at the fracture site.
Postinfectious kyphosis occurs in a manner
similar to that just described. Mechanical
integrity of the anterior column is lost due

Different types of
Kyphosis
There are many types of adult kyphosis. This section will
discuss the major types and causes of kyphosis.
Postural Kyphosis
Postural kyphosis, or "round back", is the result of poor
posture. This condition is most common in adolescents and
young adults, as they often slouch when standing and
sitting, causing the spine to curve forward.
Postural kyphosis is often accompanied by "hyperlordosis"
of the lumbar (lower) spine. The lumbar spine naturally has
a "lordosis", a backward "C"-shape. Hyperlordosis means
the lumbar spine compensates for the excessive thoracic
kyphosis by curving more in the opposite direction.

Scheuermann's Kyphosis

With Scheuermann's kyphosis, the thoracic

curve is usually 45 and 75 degrees. There
will also be vertebral wedging of greater than
five degrees of three or more vertebrae that
are next to each other. The vertebrae in
these cases have a triangular appearance, so
they wedge together and cut down the
normal space between vertebrae.

Congenital Kyphosis

Congenital kyphosis refers to abnormal

development of the spine that is inherited.
This means a person is born with some sort
of defect, such as incomplete formation of
the spine, which can lead to a severe
abnormal kyphosis. This kyphosis is also the
most common non-traumatic, non-infectious
cause of paraplegia (paralysis of the lower
part of the body).

Signs and Symptoms

The

symptoms of kyphosis can range from

causing pain to severely affecting the function of
the lungs and heart.
Kyphosis can be painful and cause pain primarily
in the area of the kyphosis.
If the curve is severe it can begin to put pressure
on the spinal cord and cause problems due to the
compression of the nerves of the spinal cord.
This can cause weakness in the lower extremities.
Finally if the kyphosis is in the thoracic spine the
curve can make it difficult to breath and affect the
function of the heart as well.

Diagnostic Evaluation
X-ray

of the spine in the upright position,

preferably on one long 36-inch cassette, show
characteristic curvature.
MRI, Myelograms, or CT scan with three
dimensional reconstruction may be indicated for
children with severe curvatures who have a
known or suspected spinal column anomaly,
before management decisions are made.
Pulmonary function tests for compromised
respiratory status.
Evaluate for renal abnormalities in children with
congenital scoliosis.

Nursing Care
Plan
Assessment
Poor posture, uneven shoulder height.
One hip more prominent than the other.
Scapular prominence.
Uneven waist line or hemline
Spinal curve observable or palpable on both
upright and bent forward.
Back pain may be present but is not a
routine finding in idiopathic scoliosis.
Leg length discrepancy.

In order to make a proper diagnosis and rule out other

possible conditions, the first step is to take a history.
The provider may ask about the following:
Family History - Some types of scoliosis, lordosis and
kyphosis tend to run in families, so it may have a
genetic cause. Your provider will want to know if
anyone else in your family has the problem.
Date of Onset - When did you first notice the
appearance of your spinal condition?
Measured Curve Progression - If X-rays have been
taken of your spine in the past, the doctor will want
to see if the curve is getting worse. This can be
measured comparing new x-rays with old ones,
measuring the size of the curve, or measuring
changes in your height.

The Presence or Absence of Pain - Not all cases produce pain.

However, if there is pain, your doctor needs to know where it

is, what brings on or intensifies the pain, and if there is any
radicular pain - pain that radiates away from the spine itself.
This usually comes from irritation of the nerves as they leave
the spine.
Bowel or Bladder Dysfunction - Are you having problems
knowing when you have to urinate or have a bowel
movement? This is extremely important because it could
signal the presence of serious nerve damage.
Motor function - Has there been a change in how your
muscles work? This may be the result of pressure on the
nerves or spinal cord itself.
Previous surgery - If you have had any surgery on your spine,
it may have caused the scoliosis, lordosis, and kyphosis due
to weakened muscles or other problems. In order to evaluate
your condition properly, it is important that your physician
knows about any spinal surgery you have had in the past.

Nursing Diagnosis
Acute pain: back related to the

position of lateral body tilt.

Ineffective
Breathing
Pattern
related to the suppression of pain.
Disturbed body image related to
negative feelings about spinal
deformity and appearance in brace.

Nursing Interventions
Dx : Acute pain: back related to the position of lateral body tilt.
- Objective: pain resolved.
- Criteria Results: Pain is missing, less or controlled
Intervention:

Assess the type, intensity and location of pain.

R : useful in evaluating the pain, determine the intervention
options, determine the effectiveness of therapy.
Adjust the position of the level of comfort.
R : reducing muscle tension and coping adequately.

Keep quiet neighborhood.

R : increasing the sense of comfort.
Teach relaxation and distraction techniques.
R : to divert attention, thus reducing pain.
Encourage postural exercises regularly.
R : with postural exercise regularly speed up the process to fix
the position of the body.
Collaboration in providing analgesic.
R : to relieve pain.

Nursing Interventions
Ineffective Breathing Pattern
related to the
suppression of pain.

Dx :

- Objective: Ineffective breathing pattern is

resolved.
- Criteria Results: Effective breathing pattern
Intervention :
Assess respiratory status every 4 hours.
R: monitor progress to determine further
action.
Help and teach the patient to perform a deep
breath every 1 hour.
R: to avoid crowded.
Adjust the position of the semi-Fowler

Auscultation chest to listen for breath

sounds every two hours.
R : monitoring the suppression of the
lung by the spine.
Monitor vital signs every 4 hours.
R : monitor the progress to determine
further action.

Dx : Impaired body image or self-concept related

to posture
tilted laterally.
- Objective: Impaired body image or self-concept is
resolved.
- Criteria Results: Improving body image.
Intervention:
Suggest to express feelings and problems.
R:
assist in ensuring a problem to start the
troubleshooting process.
Give an open environment.
R:
increase creed / positive value of the
subject and identify misconceptions / myths
that can affect the assessment of the
situation.

Discuss the patient's perception about themselves

and their relationship to change and how the patient

sees himself in the pattern/role functioning normally.
R : help define the problem in relation to the
previous
lifestyle and assist in problem solving.
Push/provide visits by people who suffer from
scoliosis, especially those that have succeeded in
rehabilitation.
R :friends in the same boat that had been through
the same experience to act as role models and
be able to give validity statement and
expectations for recovery and the normal period.

References
http://www.webmd.com/back-

pain/guide/types-of-spine-curvaturedisorders
http://www.epainassist.com/sportsinjuries/low-back-injuries/lordosis
http://patient.info/doctor/scoliosis-andkyphosis
https://www.nyboneandjoint.com/articles/sp
ine-deformities-scoliosis-kyphosis-lordosis/
http://nursingcrib.com/nursing-notesreviewer/medical-surgical-nursing/scoliosis/
https://www.medicalnewstoday.com

Thank
you