Scoliosis

>abnormal curvature of the spine (S or C shaped) >bones are rotated slightly making the person waist or shoulders appear uneven. Causes: *congenital *Neuromuscular *Idiopathic *Osteopathic

2. Congenital scoliosis asscociated with abnormalities of the vertebrae such as hemi or fused vertebrae. There is frequent association with spina bifida and there may also be a paralytic element in such cases. 3. Infantile scoliosis curve develops during the first 3 years without vertebral anomalies. There is often plagiocephaly. The curve is often thoracic or thoraco lumbar. 4. Adolescent Idiopathic scoliosis can be noticed at the age of 10 or even earlier. The prognosis depends on the age of onset and on the level of the curve. 5. Structural scoliosis possible causes are numerous, including the following: o Idiopathic o Congenital o Neuromuscular (eg. Poliomyelitis, cerebral palsy, syringomyelia, muscular dystrophy, amyotonia congenital, Friedreich's ataxia) o Neurofibromatosis o Mesenchymal disorder (eg. Marfan's syndrome, Morquio's syndrome, rheumatoid arthritis, osteogenesis imperfect, certain dwarves) o Trauma ( fractures, irradiation, surgery)

Common Types of Curves:

Classifications: 1. Nonstructural Scoliosis structurally normal spine appears curved due to one or more underlying conditions (eg hip deformity, defference in leg length, tumor or infection of the spine and spasm of the spinal muscle associated with a prolapsed disc)

Types: Mild: <25 curvature - Regular monitoring - View an X-ray of the spine every 3 mos. - No bracing or special treatment

 Moderate: 20-40 curvature

- Bracing is applied Severe: curve >40 Cobbs curvature with kyphosis -insertion of metal rods in the pt.s back and fusing together several vertebrae is seriously considered. Manifestations: >uneven shoulder >uneven waist >one hip higher than the other >leaning to one side >ribs on one side of the body to stick out farther than the other side >unequal gaps between the arms and the trunk >back pain >spine obviously curve Diagnostic tests:

b.Milwaukee brace: full torso brace has a neck ring with rests for the child and for the back of the head. c. Yamamoto brace

Physiotherapy: gives more emphasis on posture,

streghtening of muscles and correction of muscle imbalance. Surgery: SPINAL FUSION- joining of two pieces together. It involves connecting 2 or more vertebrae with pieces of bone taken from pelvis. Eventually, the vertebrae and the pieces of bone fuse together preventing further progression of the curve. Instrumentation: 1. Harrington Procedure 2. Cotrel-Dubousset Procedure

1. Physical Examination:
2. 3. 4. 5. 6. 7. (Adams Forward Bending Test) X-rays Magnetic Resonance Imaging (MRI) Blood tests Computed Tomography Scan (CT Scan) Sonography Radionuclide bone scan Treatment:

Nursing Management Assess for skin irritation. Assess for movement, color and sensation Teach to aid use use of powder and lotion Instruct to use undergarments to reduce friction Instruct to loosen brace during meals and for the 1st 30 mins after meals.

Braces: prevents further

progression of the curve a.Underarm or low profile brace aka thoracolumbar orthosis (TLSO)