SCOLIOSIS

It is the lateral curvature of the spine may

occur in the thoracic, lumbar, or
thoracolumbar segment.

The curve may be convex to the right (more
common in thoracic curves) or to the left
(more common in lumbar curves)

Rotation of the vertebrae column around its
axis occurs and may cause rib cage deformity.

Functional

Structural
Congenital
Neuromuscular
Degenerative
Idiopathic

Structural

Nonstructural
A tilted head that does not line up over the
hips
Protruding shoulder blades
Asymmetrical waist line one hip or shoulder
that is higher than the other, causing an
uneven hem or shirt line
Uneven neckline
A sideways lean- leaning more to one side
than the other
In developing girls, breast appear to be
unequal in size
Rib hump one side of the upper back is
higher than the other when the child bends
over, knees together, with the arms dangling
down
Severe scoliosis can cause back pain and
difficulty breathing.

-Mild scoliosis - <25 degrees
-Moderate scoliosis between 25 and 40
degrees
-Dangerous 40 degrees or more
Severe scoliosis 70 degrees
Very severe over 100 degrees

Adams forward bending test patient place her palms
together and slowly bend forward, feet together and knees
straight while dangling the arms and keeping her head
down.
Scoliometer - can be used to measure and
estimate the rotation of the spinal curve.

X-ray of the spine may be taken to get a more
precise measurement of the spinal curve.

Cobb method calculates the degree of the
curve
MRI identify spinal cord and brain stem
abnormalities.

MRI identify spinal cord and brain stem abnormalities.
In the physical exam, the doctor will observe
posture, range of motion, and physical
condition, noting any movements that cause
pain. The doctor will feel the spine, note its
curvature and alignment, and feel for muscle
spasm.

During the neurological exam, the doctor will
test reflexes, muscle strength, other nerve
changes, and pain spread. This is all to get a
better picture of general health.

Congenital Scoliosis

Disturbance in vertebral development during six to eight weeks of embryonic
development


Failure of formation
Failure of segmentation
Absence of portion
of the vertebra.
-hemivertebra
(absence of the
whole side of
vertebrae).
-wedge
vertebrae(missing
only one portion of
the vertebrae).

Absence of normal separation between vertebrae.
Anomalies and neurologic complications if the spine is involved.
Absence of normal separation between vertebrae.
Anomalies and neurologic complications if the spine is involved.
Absence of normal separation between vertebrae.
Anomalies and neurologic complications if the spine is involved.
Absence of normal
separation between
vertebrae.

Anomalies and
neurologic
complications if the
spine is involved.

Neuromuscular Scoliosis Neuropathic/Myopathic
dse.( Cerebral palsy, Myodysplasia poliomyelitis) C-
shaped curved from the cervical to the sacral region.

Idiopathic Scoliosis- no known cause has
been established. Considering hereditary
(mother-daugther) but identical twins are not
uniformly affected.

Brace management goal is to prevent
progression of the curve. Yamamoto,
Milwaukee

Cast: Rizzers jacket, Minerva(not commonly
used)

Traction: Halo-pelvic, Halo-femoral, Cotrels

Surgery: Spinal fusion

Prepare the patient for casting or immobilization
procedure by showing materials to be used and describing
procedure in age-appropriate terms.

Promote comfort with proper fit of brace or cast.

Provide opportunity for the child to express fears and ask
questions about deformity and brace wear.

Assess skin integrity under and around the brace or cast
frequently.

Provide good skin care to prevent breakdown around any
pressure areas.

Instruct the patient to examine brace daily for
signs of loosening or breakage.

Instruct patient to wear cotton shirt under brace
to avoid rubbing.

Instruct about which previous activities can be
continued in the brace.

Provide a peer support person when possible so
the child can associate positive outcomes and
experiences from others.

Promoting positive body image

Encourage patient to express feelings and concerns about body
image.

Encourage patient to express concerns about wearing a brace.

Discuss options for brace wearing .

Encourage patient to discuss scoliosis with his/her peers,
including disease process and treatment.

Provide a peer support when possible so the child can associate
positive outcomes and expression from others.