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Definition
II. Etiology
III. Epidemiology
To understand scoliosis, which causes the spine to curve to the left or right, you first
need to understand what a normal spine looks like. There are four regions in your spine:
• Cervical Spine: This is your neck, which begins at the base of your skull. It
contains 7 small bones (vertebrae), which doctors label C1 to C7 (the 'C' means
cervical). The numbers 1 to 7 indicate the level of the vertebrae. C1 is closest to
the skull, while C7 is closest to the chest.
• Thoracic Spine: Your mid-back has 12 vertebrae that are labeled T1 to T12 (the
'T' means thoracic). Vertebrae in your thoracic spine connect to your ribs, making
this part of your spine relatively stiff and stable. Your thoracic spine doesn't move
as much as the other regions of your spine, like the cervical spine.
• Lumbar Spine: In your low back, you have 5 vertebrae that are labeled L1 to L5
(the 'L' means lumbar). These vertebrae are your largest and strongest
vertebrae, responsible for carrying a lot of your body's weight. The lumbar
vertebrae are also your last "true" vertebrae; down from this region, your
vertebrae are fused. In fact, L5 may even be fused with part of your sacrum.
• Sacrum and Coccyx: The sacrum has 5 vertebrae that usually fuse by
adulthood to form one bone; the coccyx—most commonly known as your tail
bone—has 4 (but sometimes 5) fused vertebrae.
From behind, the normal spine appears straight. However, when viewed from the
side, you'll see that the spine has both inward and outward curves. These curves help
our back carry our weight and are also important for flexibility.
There are two types of curves in your spine: kyphosis and lordosis. You can see
those from the side view. Kyphosis means the spine curves inward; lordosis means the
spine curves outward. There are two kyphotic and two lordotic spinal curves in a normal
spine. Your neck (cervical spine) and low back (lumbar spine) have a lordotic curve. Your
mid back (thoracic spine) and pelvis (sacrum) have a kyphotic curve.
V. Pathophysiology:
VI. Manifestation
1. The Adam's Forward Bending Test helps identify an unusual curve, but it can't
tell you how severe the curve is. For that, you'll need to go to a doctor. Using
different tests, the doctor will be able to see and measure the curve.
2. Plumb line test: This is a quick visual check to see if the spine is straight. In
scoliosis, the plumb line will fall to the left or right of the spine instead of through
the middle of the buttocks.
3. Scoliometer: If the doctor sees a rib hump, he or she can use a scoliometer to
measure the size of the hump. It's a painless and non-invasive test.
4. X-ray: An x-ray can help the doctor confirm scoliosis by showing exactly where
the scoliosis affects the spine and the extent of the curve.
5. Plain Radiographs (X-Rays): X-rays are not "routinely" necessary for most
episodes of acute low back pain and have generally been overused. The main
purpose of plain x-ray is to detect serious underlying structural, pathologic
conditions. Selective criteria can be used to improve the usefulness of plain x-ray.
These studies are generally not recommended in the first month of symptoms in
the absence of "red flags." Oblique views are rarely indicated and increase both
the cost and radiation exposure. The exception would include a young patient
with an acute injury or repetitive extension activities, which can result in fracture
of the pars interarticularis.
VIII. Treatments
• Conservative treatment:
• Surgery
a. ROM exercises
b. Active restrictive exercises ( performed against resistance of
another person or with weights)
• Medications: medications are rarely needed except for salicylates for anti-
inflammatory and analgesic effects.
• Nutrition: a special diet is usually not prescribed except when the patient is
overweight or laboratory studies indicate metabolic problems such as rickets.
Assist the patient and family in planning meals that include fruits, and vegetables,
proteins, and vitamins.
• Teach clients in ways to reduce irritation of skin surfaces beneath the brace:
wearing a smooth cotton t-shirt or cotton tube under the brace at all times,
changing undergarments at least once daily, and washing them with a mild soap.
Undergarments should be changed more frequently in warmer weather.
• Teach the client to loosen braces during meals and for the first 30 minutes after
each meal because these allows adequate nutritional intake and promote
comfort.
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