SCOLIOSIS

Submitted by:
Felicano, Katherine
Aquino, Ghen

Submitted to:
Sir Leonardo de Guzman

Synonym: Rib Hump

Definition: is a lateral (sideways) curvature of the spine. It may involve all
or only a portion of the spinal column. It may be: Functional (a curve caused
by a secondary problem), or it can be structural (a primary deformity).
Functional scoliosis occurs as a compensatory mechanism in
children who have unequal leg lengths, and sometimes in children with
ocular refractive errors that cause them constantly to tilt their head
sideways. The curve that occurs in functional scoliosis tends to be a C-
shaped curve. Functional scoliosis is a disorder that can be corrected.
Structural scoliosis is idiopathic, permanent curvature of the spine
accompanied by damage to the vertebrae. The curve that occurs in
structural scoliosis tends to be an S-shaped curve.
Risk Factor:
• 80% of cases there is no known cause. Idiopathic.
• Age - scoliosis signs and symptoms often start during a growth spurt
that occurs just before puberty. Peak incidence at 8-15 yrs old. As the
child is growing, the spinal curves will become more severe.
• Gender - females have a higher risk of worsening symptoms. 5 times
more common in girls than boys.
• Genetics - people with scoliosis are more likely to have close relatives
with the same condition than other people.
Sign and symptoms:
· Shoulders may not be of the same height (one is higher than the
other)
· Head is not centered directly above the pelvis
· Ribcage is not symmetrical; ribs may be at different heights
· A shoulder blade is higher and more prominent than the other
· One hip is more prominent than the other
· Clothes do not hang properly
· The individual may lean to one side
· Uneven leg lengths
Laboratory and diagnostic work-ups:
• Radiography: is most often used noninvasive test for detecting bony
abnormalities. Radiographs are used a screening tool to establish the
presence of a skeletal problem; it do not show soft
tissue/tendon/ligaments abnormalities.
• Magnetic resonance imaging: uses large magnets to produce a
detailed image of soft tissue as well as bone. It is used to detect
conditions affecting the tendons, ligaments, and fractures.
•
Nursing Diagnosis:
• Situational low self-esteem related to obviousness of the braces
used for scoliosis
Cues:
Verbal report of current situational changes
Obvious of brace used to correct scoliosis

• Disturbed Body Image related to biophysical illness

 Cues:
Verbalization of feelings that reflect an altered view of
one’s body
Fear of rejection by others
Negative feeling about body
Behaviours’ of avoindance of one’s body
Change in social involvement
• Deficient Knowledge related to lack of information/
misinterpretation
Cues:
Verbalization of the problem
Inappropriate/ exaggerated behaviours
Other possible nursing diagnosis:
• Pain related to the extent of the defect or surgery
• Anxiety related to hospitalization and surgery
• Impaired skin integrity related to pressure from braces, traction or
casts.
• Potential for serious post operative complications (neurology
impaired, shock, infection, urinary retention, paralytic ileus and
cardiopulmonary problems) related to surgery.

Management of Scoliosis

The management of a scoliosis is determined by the extent of the scoliosis. A

number of methods are used to decide upon the most appropriate treatment.
In most instances a mild scoliosis requires no specific treatment. Advice in
regard to posture and exercises may be offered. If the scoliosis is more
severe it must be treated.
• If the curve is less than 25°, no treatment is required, and the child can
be re-examined every four to six months.
• If the curve is more than 25° but less than 30°, a back brace may be
used for treatment.
• Curves more than 45° will need to be evaluated for the possibility of
surgical correction. Surgical correction involves fusing vertebrae together
to correct the curvature and may require inserting rods next to the spine
to reinforce the surgery.
• Treatment options depend more on how likely it is that the curve will
worsen than on the angle of the curve itself. A child with a 20° curve and
four more years of growth may require treatment while a child with 29° of
curvature who has stopped growing may not require treatment.
The options are:

1. Bracing
Although a definite inconvenience, bracing is sometimes necessary, and may
prevent the need for surgery. A recent study has shown that bracing is
effective in stopping the progression of the curve in about 80 per cent of
patients, until the age of 16. A variable degree of relapse of the curve does
occur after the cessation of bracing, usually at the age of 15 - 16. However,
those children who have been braced generally still have curves within the
acceptable range, which should not carry any particular disadvantage into
adulthood.

Braces
If a child has a curve of 25 to 40 degrees and is still growing, the doctor may
recommend using a brace. Wearing a brace won't cure or reverse scoliosis
but it usually prevents further progression of the curve. Most braces are
worn all the time, during the day and night. Scoliosis braces can prevent
progression and the need for surgical treatment up to 90 percent of the time.
Like many treatments, scoliosis braces are only effective if they are worn as
directed. Both the child and the child's family need to understand the
importance of wearing the brace. Once the skeleton is mature — about 15 to
16 years old for girls and 17 to 18 years old for boys — or if the curve is too
large — more than 40 to 45 degrees — a brace won't help. Braces aren't
useful for the treatment of congenital scoliosis because the curve is caused
by abnormally shaped bones in the spine. Braces are of two main types:
Underarm or low-profile brace. This type of brace is made of modern
plastic materials and is contoured to conform to the body. Also called a
thoracolumbosacral orthosis (TLSO), this close-fitting brace is almost invisible
under the clothes, as it fits under the arms and around the rib cage, lower
back and hips. A custom brace is molded to place corrective forces on the
curve. Other types of braces place pads in areas to stabilize the curve.
•Milwaukee brace. This full-torso brace has a neck ring with rests for the
chin and for the back of the head. The brace has a flat bar in the front and
two flat bars in the back. A Milwaukee brace may be used for curves in the
upper spine. However, this brace is not commonly used today.

2. Physiotherapy

Surface electrical stimulation has now been discredited as a treatment, and

studies have shown that the children treated in this way do no better than
those left untreated. Treatment such as manipulation has no place in the
management of the mechanical defect in scoliosis, although manipulation
and physical therapies can help any low back pain that occurs in association
with a scoliosis. In the majority of functional scoliosis, Physiotherapists can
give advice regarding:
• Posture;
• Strengthening of muscles and correction of muscle imbalance;
• Strapping;
• Ergonomics;
• Exercise.

Exercises can be prescribed, but they will probably not affect the progression
of a curve. If a brace is required, an exercise programme will also be
prescribed, but if not required, instruction regarding review of the scoliosis
and exercises will be provided.

3. Surgery

In the rare cases where the scoliosis reaches the point of no return, surgery
may be required. In thoracic scoliosis it entails the insertion of metal rods -
called Cotrel-Dubousset Instrumentation - along the spine. These rods act
as braces to straighten the spine and prevent further deterioration of the
scoliosis. These rods are usually left in the spine throughout life. These
operations are performed by Orthopaedic Surgeons, who are specialised in
the area of Paediatric Orthopaedics. This type of surgery does not require the
patient to wear a plaster jacket after the operation. The stay in hospital is
about 7 to 9 days, and return to school is about 1 month. Life after surgery
returns to near normal by about 9 months, except that body contact sports
are not permitted. Lumbar scoliosis is treated with other operations including
fusion, and the underarm brace is required for up to 6 months after surgery.

• Spinal Fusion- Two or more vertebrae are fused together,using bone

grafts and metal rods and screws.
• Halo Traction: it is use of opposing forces to straighten and reduce
spinal curves that are severe when first diagnosed or that progress
despite bracing. Halo traction is achieved using a ring of metal (a halo)
held in place with about four stainless steel pins inserted into the skull
bones. Counter traction is applied by pins inserted into the distal femurs
or iliac crests. Halo traction is typically used for children who have
respiratory involvement, cervical instability, a high thoracic deformity, or
decreased vital capacity from severe spinal curvature and rotation.
Surgery
If a child's curve is greater than 40 to 50 degrees, the doctor will likely
recommend surgery because scoliosis of this size tends to get worse
throughout a child's lifetime. Scoliosis surgery involves techniques to fuse or
join the vertebrae along the curve. Surgery is most commonly done through
an incision in the middle of the back. For very rigid or severe curves,
additional surgery may be needed through the side of the body. "Fusion"
means joining two pieces together. In the treatment of scoliosis, fusion
involves connecting two or more of the bones in your spine (vertebrae) with
new bone. The process is similar to what occurs when a broken bone heals.
Eventually, the vertebrae fuse together preventing further progression of the
curve. Doctors attach metal rods, hooks, screws or wires (implants) to the
spine to hold the vertebrae together during the months after surgery while
the bones fuse or heal together. The implants are left in the body, even after
the bones have fused, to avoid another surgery. These implants can't be
seen or felt. In addition to supporting the fused area, implants also apply
force to the spine to help correct the deformity and help straighten the
curve. Scoliosis surgery is a complicated orthopedic surgical procedure. The
operation takes several hours. Hospitalization can last five to seven days,
and activities are restricted for several months. The results of surgery are
usually very good, with dramatic improvement in the scoliosis curve size.