Scoliosis

y Anfone,Mary Joy M. y BSN-223/ group 89

scoliosis
y is a disorder that causes an abnormal curve of the spine,

or backbone. y it is the lateral or sideways curve of spine that is apparent when viewing the spine from behind. PARTS: Cervical Thoracic Lumbar

y . The spine has normal curves when looking from the

side, but it should appear straight when looking from the front. Kyphosis is a curve seen from the side in which the spine is bent forward. Lordosis is a curve seen from the side in which the spine is bent backward. People with scoliosis develop additional curves to either side, and the bones of the spine twist on each other like a corkscrew.

Classification/ types:
y Non - structural

-postural scoliosis - not fixed deformity y Structural scoliosis - idiopathic(70-80%) - congenital - paralytic

Risk Factors:
y Some people may be prone to curving of the spine. Most

cases occur in girls. Curves generally worsen during growth spurts. Scoliosis in infants and young children are less common, and commonly affect boys and girls equally.

Predisposing factors
y Genetic inheritance - Scoliosis is hereditary in that people

with scoliosis are more likely to have children with scoliosis; however, there is no correlation between the severity of the curve from one generation to the next. y Sex - Scoliosis is about two times more common in girls than boys. y Age - It can be seen at any age, but it is most common in those over 10 years old.

Etiology:
y Idiopathic-accounts for 80% cases, possible familial y y

y y

incidence. Congenital-failure of vertebral formation and segmentation Neuropathic- associated with conditions such as poliomyelitis, cerebral palsy, paralysis and neuro fibromatosis. Myopathic- results from conditins such as dystrophy and myopathies Osteopathic results from conditions such as fracture, bone disease, arthritis and infection.

3 general Causes:
y Congenital scoliosis y Neuromuscular scoliosis y Idiopathic scoliosis

pathophysiology
y Many studies have attempted to uncover the

pathophysiologic process underlying idiopathic scoliosis. Multiple abnormalities have been found, yet none has been conclusively linked to all cases.

Diagnostic Examination:
y Physical examination forward bending test, to define y y y y

the curve of the spine. Spine x-ray MRI (if there are any neurologic changes noted on the exam or if there is something unusual in the x-ray ) Neurologic Examination to look for any changes in strength, sensation or reflexes. Scoliometer measurements (a device used for measuring the curvature of the spine).

Signs & symptoms

y A doctor may suspect scoliosis if one shoulder appears to be higher y y y y y y y

than the other, or the pelvis appears to be tilted. Untrained observers often do not notice the curving in the earlier stages. Other symptoms can include: Backache or low-back pain Fatigue Shoulders or hips appear uneven Spine curves abnormally to the side (laterally) There may be fatigue in the spine after prolonged sitting or standing. Pain will become persistent if there is irritation to the soft tissue and wear and tear of the spine bones. Note: Kyphoscoliosis also involves abnormal front to back curvature, with a "rounded back" appearance.

Interventions
As curves get worse (above 25 to 30 degrees in a child who is still growing), bracing is usually recommended to help slow the progression of the curve. There are many different kinds of braces used. The Boston Brace, Wilmington Brace, Milwaukee Brace, and Charleston Brace are named for the centers where they were developed.

y A back brace does not reverse the curve. Instead, it uses

pressure to help straighten the spine. The brace can be adjusted with growth. Bracing does not work in congenital or neuromuscular scoliosis, and is less effective in infantile and juvenile idiopathic scoliosis

Surgical management
y The choice of when to have surgery will vary. After the bones of the skeleton stop growing, the curve should not get much worse. Because of this, the surgeon may want to wait until your child s bones stop growing. But your child may need surgery before this if the curve in their spine is severe or is getting worse quickly. Curves of 40 degrees or greater usually require surgery. y Surgery involves correcting the curve (although not all the way) and fusing the bones in the curve together. The bones are held in place with one or two metal rods held down with hooks and screws until the bone heals together. Sometimes surgery is done through a cut in the back, on the abdomen, or beneath the ribs. A brace may be required to stabilize the spine after surgery.

Nursing Management
y Care for patient with cast for immobilization. y Promote comfort with proper fit of brace or cast. y Assess skin integrity under and around the brace or cast. y Provide good skin care to prevent skin breakdown around

any pressure areas. y Support for body image disturbance.

Problem Prioritization

Nursing Diagnosis Risk for injury related to postoperative complications.

Rank

Justification

This is an actual problem and is health threatening. This should be addressed first because it can affect the present health state of the person.

Risk for impaired skin integrity related to mechanical irritation to brace. 2

This is an actual problem and is health threatening. This belongs to first level of Maslow s Hierarchy of needs which is physiologic needs. Treating this problem will give energy to the patient thus treating the underlying problems will be supported.

Disturbed body image related to negative feelings about spinal deformity and appearance in brace. 3

This is an actual problem. It requires the client s emotional and psychological factors that will be needed in the intervention.