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I.

Definition

Scoliosis (from Greek: skolíōsis meaning "crooked") is a medical condition in


which a person's spine is curved from side to side, shaped like an "s or c", and may also
be rotated. To adults it can be very painful. It is an abnormal lateral curvature of the
spine. On an x-ray, the spine of an individual with a typical scoliosis may look more like
an "S" or a "C" than a straight line.

II. Etiology

It is typically classified as: 1.) congenital (caused by vertebral anomalies present


at birth), 2.) idiopathic (sub-classified as infantile, juvenile, adolescent, or adult
according to when onset occurred), 3.) Neuropathic ( associated with conditions such
as poliomyelitis, cerebral palsy, paralysis and neurofibromatosis), 4.) myopathic (rusults
from conditions such as muscular dystrophy and myopathies), and 5.) osteopathic
(results from conditions such as fractures, bone diseases, arthritis and infection).

III. Epidemiology

1. Prevalence: 2% of adolescent population


2. Age
a. Girls: After 9-10 years old
b. Boys: After 11-12 years old
3. Gender
a. Boys and girls affected equally
b. Girls are much more likely to significantly progress

IV. Anatomy and Physiology

• The Spinal Column

The spinal column consists of individual bones called vertebrae, the


building blocks, which provide support for the spine. These vertebrae are
connected in the front of the spine by intervertebral discs. Discs are very strong
tissues, which are filled with a gel. Discs help to support the spine, and also allow
it to move. Many ligaments and muscles attached to the back of the spine
(posterior aspect) provide power for movement.

• Vertebrae in the Spinal Column


You may have heard your doctor using such terms as lumbar spine, or L5.
These terms are easy and important to understand. The spinal column consists
of:

1. seven cervical vertebrae (C1–C7) i.e. neck


2. twelve thoracic vertebrae (T1–T12) i.e. upper back
3. five lumbar vertebrae (L1–L5) i.e. lower back
4. five bones (that are joined, or "fused," together in adults) to form the bony
sacrum
5. three to five bones fused together to form the coccyx or tailbone.

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. Whole body leaning to one side


2. Uneven shoulder height
3. One hip sticks up higher than the other (Parents often first notice possible
scoliosis when they see that one pant leg is shorter than the other.)
4. Uneven rib cage
5. Rib protrusion on one side of the spine

o Scoliosis screening should begin at age 6 years


o Right thoracic and left lumbar curvature is the norm
o Landmarks
 Shoulder height
 Scapular prominence
 Flank crease
 Pelvic symmetry
 Leg Length Discrepancy
o See Scoliosis Examination
 Forward Bending Test
 Scoliometer (measures trunk rotation)
 Adam's Test
o Determine growth spurt
 Assessment Tools
 Measure Sitting Height (Truncal Height) q3 months
 Obtain Risser Grading (Iliac XRay)
o Functional exam
 Neurologic Exam
 Gait
o Red Flags
 Left thoracic curve (possible spinal cord lesion)
 Neurofibromatosis stigmata
 Marfan's Syndrome stigmata

VII. Diagnostic Test

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:

Braces, electrical stimulation, and traction may be used to prevent


progression of scoliosis and kyphosis in younger clients whose skeletons have
not yet matured. Unfortunately, these approaches are ineffective in adult clients.
Conservative treatments for adults include weight reduction, active and passive
exercises, and the use of braces for support.

• Surgery

For adolescents and adults, the use of surgery to correct spinal


deformities depend on the factors such as degree of curvature and the client’s
aver-all physical, emotional, and neurologist status. Even with surgery, it is not
possible to correct the abnormal curvature completely. The surgical procedures
involve attaching metal reinforcing rods to the vertebrae, and are usually
performed using an interior approach, although more severe curvature may
require both anterior and posterior approach. The types of straightening devices
used most frequently are bilateral rods with wire hooks or screws that stabilize
the spine and correct the deformity.

IX. Nursing Diagnosis

1. Potential alteration in comfort


2. Potential activity intolerance
3. Risk for injury
4. Risk for peripheral neurovascular dysfunction

X. Planning and Implementation


• Counseling and teaching: splint or brace use (Milwaukee or Orthoplast braces
are commonly used). Teach the patient to apply and remove the splint or brace
and how to care for it.
• Therapeutic exercises: exercises are prescribed forms of activity designed to
preserve joint mobility and to strengthen specific muscle group. These may
include the following:

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.

XI. Evaluation and Outcome

1. Expected patient outcomes:

• Patient avoids potential complications.


• Patient maintains maximal functioning and independence.
• Patient participates in long-range planning of care.

2. Evaluation for conservative therapy:

• Based on the expected patient outcomes, the questions related to therapy


would include the following:

a. Have spinal complications been avoided?


b. To what degree has the patient been able to function without back
support?
c. Is the patient able to describe long-range plans of care?

3. Evaluation for patient with spinal fusion:

• Based on the expected patient outcomes, the patient:


a. Can explain the nature of the surgery that has been performed.
b. Maintains maximum functioning
c. Is participating in physician’s follow-up program.
“SCOLIOSIS”

Submitted by:

BELTRAN, Karl Leo D.


BOLANTE, Sheila Marie H.
BSN033

Submitted To:

Prof. Pepito B. Ruzol Jr.

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