SCOLIOSIS

> a disorder that causes an abnormal curve of the spine, or backbone. > The spine has normal curves when looking from the side, but it should appear straight when looking from the front.

> it is about two times more common in girls than boys. It can be seen at any age, but it is most common in those over 10 years old. > it 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.

CAUSES: > the cause of scoliosis is unknown (idiopathic). Scoliosis is described based on the age when scoliosis develops. If the person is less than 3 years old, it is called infantile idiopathic scoliosis. >Scoliosis that develops between 3 and 10 years of age is called juvenile idiopathic scoliosis, and people that are over 10 years old have adolescent idiopathic scoliosis.

There are three other main types of scoliosis:

Functional: > In this type of scoliosis, the spine is normal, but an abnormal curve develops because of a problem somewhere else in the body. This could be caused by one leg being shorter than the other or by muscle spasms in the back.

Neuromuscular: > In this type of scoliosis, there is a problem when the bones of the spine are formed. Either the bones of the spine fail to form completely, or they fail to separate from each other. > This type of scoliosis develops in people with other disorders including birth defects, muscular dystrophy, cerebral palsy, or Marfan's disease. If the curve is present at birth, it is called congenital. This type of scoliosis is often much more severe and needs more aggressive treatment than other forms of scoliosis.

Degenerative: >Unlike the other forms of scoliosis that are found in children and teens, degenerative scoliosis occurs in older adults. >It is caused by changes in the spine due to arthritis. Weakening of the normal ligaments and other soft tissues of the spine combined with abnormal bone spurs can lead to an abnormal curvature of the spine.

S/SX: > The spine curves abnormally to the side (laterally) >Shoulders or hips appearing uneven Backache or low-back pain >Fatigue > One shoulder is higher than the other >One shoulder blade sticks out more than the other >One side of the rib cage appears higher than the other >One hip appears higher or more prominent than the other >The waist appear uneven

Signs and tests: >The health care provider will perform a physical exam, which includes a forward bending test that will help the doctor define the curve. The test is called Adams bending forward test. >The degree of curve seen on an exam may underestimate the actual curve seen on an x-ray, so any child found with a curve is likely to be referred for an x-ray. >The health care provider will perform a neurologic exam to look for any changes in strength, sensation, or reflexes.

Physical examination Physical examination includes a neurological exam too. During this comprehensive examination, we evaluate movement limitations, balance problems, pain, extremity reflexes, muscle weakness, sensation, and other matters related to your health. Part of your exam may include a series of movements such as bending sideways, forward and backward at the waist, and walking. The doctor may measure your legs to see if there is any difference in length.

PATHOPHYSIOLOGY

> The pathophysiology scoliosis is not well understood. One problem is that a number of completely different conditions can cause the spine to curve. > Unfortunately in most people there doesn't seem to be a clear cause. They thought that either muscle weakness or muscle spasms could cause it but both are found in the condition. There is definitely a genetic link but unfortunately a clear understanding of scoliosis still awaits the medical community and the people who have it.

Laboratory/ Medical exams: > Spine x-rays (taken from the front and the side) >Scoliometer measurements (a device for measuring the curvature of the spine) >MRI (if there are any neurologic changes noted on the exam or if there is something unusual in the x-ray )

Surgical Management: > bracing is usually recommended to help slow the progression of the curve. >There are many different kinds of braces used. -Forrester Brace, -Yamamoto Brace, -Milwaukee Brace, and -Jewet Brace

Surgical Management Spinal fusion >In this procedure, bone is grafted to the vertebrae so that when it heals they will form one solid bone mass and the vertebral column becomes rigid. This prevents worsening of the curve, at the expense of some spinal movement. This can be performed from the anterior (front) aspect of the spine by entering the thoracic or abdominal cavity or, more commonly, performed from the back (posterior). A combination is used in more severe cases.

There are two main types of surgery: Anterior fusion: This surgical approach is through an incision (cut) at the side of the chest wall Posterior fusion: This surgical approach is through an incision on the back and involves the use of metal instrumentation to correct the curve. One or both of these surgical procedures may be needed. The surgery may be done in one or two stages and, on average, will take four to eight hours.

Thoracoplasty > is the removal (or resection) of typically four to six segments of adjacent ribs that protrude. Each segment is one to two inches long. > A complementary surgical procedure a surgeon may recommend is called thoracoplasty (also called costoplasty). This is a procedure to reduce the rib hump that affects most scoliosis patients with a thoracic curve. A rib hump is evidence that there is some rotational deformity to the spine. Thoracoplasty may also be performed to obtain bone grafts from the ribs instead of the pelvis, regardless of whether a rib hump is present. Thoracoplasty can be performed as part of a spinal fusion or as a separate surgery, entirely.

Nursing Diagnosis:

>Disturbed body image related to negative feelings about spinal deformity and appearance in brace. >Risk for impaired skin integrity related to mechanical irritation to brace. >Risk for injury related to postoperative complications.

Nursing Intervention

>Promote comfort with proper fit of brace or cast. >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.

Prevention:

> Prevention is impossible as the causes of Scoliosis are, as yet, unknown. Nevertheless prompt detection can prevent the long-term effects of Scoliosis from setting in. There has, however, been some evidence that correcting under-lying symptoms such as differences in leg length and ensuring a healthy, balanced diet is maintained can help by eliminating any imbalances in posture within the body. Such activities as playing a lopsided instrument e.g. flute or violin can also compound any tendencies a person may have for developing Scoliosis.