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Abegail S. Regalado


is an abnormal
curving of the
is a lateral
(toward the
side) curvature
in the normally
straight vertical
line of the


Functional scoliosis:
this involves a spine that is structurally
normal yet appears curved. This is a
temporary curve that changes, and is
caused by an underlying condition such
as difference in leg length, muscle
spasms or inflammatory conditions
such as appendicitis. Physicians usually
treat this type of scoliosis by
addressing the underlying condition.

Structural scoliosis:
is idiopathic, permanent
curvature of the spine
accompanied by damage to
the vertebrae. The spine
assumes a primary lateral

Types of Scoliosis that Affect


infantile scoliosis
juvenile scoliosis
adolescent idiopathic

Infantile scoliosis
occurs before age three and is
seen more frequently in boys.
Although neurologic
involvement is possible, many
resolve spontaneously. Some
may progress to severe

Juvenile scoliosis
is found more frequently in
girls between the ages of 3
and 10. These curves are at
a high risk for progression
and often require surgical

occurs between age 10 and skeletal
maturity. AIS may start at the onset
of puberty or becomes apparent
during an adolescent growth spurt.
Females are at higher risk, often
requiring surgical treatment, if nonoperative treatment fails to halt

Scoliosis can be :
Congenital, meaning it was
caused by a vertebral defect
discovered at birth.
Idiopathic scoliosis simply
means the scoliosis occurred
without known cause.

Risk factors:
Sex. Girls ages 3 and older are more
likely to have scoliosis than boys. In
contrast, boys are more likely to have
the disorder than girls before age 3.
Age. The younger a child is when
scoliosis begins, the more severe the
condition is likely to become.
Angle of the curve. The greater that
angle of curve, the increased likelihood
that the condition will get worse.


Curves in the
middle to lower spine are less
likely to worsen than those of
the upper spine.
Spinal problems at birth.
Children who are born with
scoliosis (congenital scoliosis)
may experience rapid
worsening of the curve.

Symptoms of Scoliosis
Backache or low-back pain
Tired feeling in the spine after
sitting or standing for a long time
Uneven hips or shoulders (one
shoulder may be higher than the
Spine curves more to one side

Poor posture, uneven
shoulder height.
One hip more prominent
than the other.
Scapular prominence.
Uneven waist line or
Spinal curve observable or
palpable on both upright
and bent forward.
Back pain may be present
but is not a routine finding in
idiopathic scoliosis.
Leg length discrepancy.

Diagnostic evaluation
X-ray of the spine in the upright position,
preferably on one long 36-inch cassette, show
characteristic curvature.
MRI, myelograms, or CT scan with three
dimensional reconstruction may be indicated for
children with severe curvatures who have a
known or suspected spinal column anomaly,
before management decisions are made.
Pulmonary function tests for compromised
respiratory status.
Evaluate for renal abnormalities in children
with congenital scoliosis.

Examples of Images Showing Scoliosis

Thoracic Curve



Lung and heart damage.the rib cage

may press against the lungs and heart,
making it more difficult to breathe and
harder for the heart to pump.
Back problems.chronic back pain than
are people in the general population.
Appearance.including unlevel
shoulders, prominent ribs, uneven hips,
and a shift of the waist and trunk to the
side. Individuals with scoliosis often
become self-conscious about their


treatment plan is determined

by the child's age, remaining
growth potential, curve
pattern and magnitude,
anticipated rate of
progression, and appearance

taught by physical therapy
are often very helpful for
good back health and
flexibility. These exercises
should be use daily and can
often replace the need for

Spinal Bracing

Today plaster
jackets are
used to treat
some cases of

Typically bracing is prescribed for

children with smaller curves ranging
from 20 to 40 degrees. Bracing may
temporarily correct the scoliosis but
does not cure the disease.
Children and teenagers may find
bracing difficult because the brace can
be uncomfortable, hot, rigid,
unattractive, and must be worn 16 to
23 hours a day. Although well
disguised under clothing, it can make a
child self-conscious.

Bracing is usually not

prescribed when the curve is
greater than 40 degrees.
Certain types of curves do not
respond to bracing, such as
high thoracic curves. In those
situations, surgical
intervention may be

Surgery to Correct Scoliosis greater than 40-50 degree

Rods, bars, wires, screws, and

other types of medically designed
hardware are used to surgically
control and correct scoliosis. These
procedures may enable the child to
sit upright, thereby reducing the
risk for cardiopulmonary

Furthermore, instrumentation
(hardware) may increase the child's
ability to be mobile. These devices
are meant to hold the spine straight
while the process of fusion occurs.
In infantile and juvenile scoliosis, rods
may be implanted without bone
grafts. Bone grafts facilitate fusion.
Later in life, spinal instrumentation
and fusion provide a more permanent
Adolescent scoliosis may be treated
surgically using spinal

The goals of spinal

instrumentation include:
stabilization of spinal
deformity correction within
safe parameters
enchancing spinal fusion

Nursing management
Prepare the child 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.


also known as a round back or hunchback,
is a condition in which the spine in the
upper back has an excessive curvature.
The upper back, or thoracic region of the
spine, is supposed to have a slight natural
It occurs when this natural arch is larger
than normal. refers to the normal convex
curvature of the spine as it occurs in the
thoracic and sacral regions.

can be congenital (present at
aging (especially if you have poor
muscle weakness in the upper back
Scheuermanns disease (occurs in
children and has no known cause)
arthritis or other bone degeneration

osteoporosis (loss of bone strength due to

injury to the spine
slipped discs
scoliosis (spinal curvature)
infection in the spine
birth defects, such as spina bifida
Pagets disease
muscular dystrophy

Clinical manifestation
Difference in shoulder
The head bends forward
compared to the rest of
the body
Difference in shoulder
blade height or position
When bending forward,
the height of the upper
back appears higher than
Tight hamstrings (back
thigh) muscles

Types of Kyphosis

Postural kyphosis
the most common type,
normally attributed toslouching,
can occur in both the old and the
young. In the young, it can be
called 'slouching' and is
reversible by correcting
muscular imbalances. In the old,
it may be a case of
hyperkyphosis and called
'dowagers hump

Scheuermanns kyphosis
is significantly worse cosmetically and
can cause varying degrees of pain, and
can also affect different areas of the spine
(the most common being the midthoracic
area). Scheuermann's kyphosis is
considered a form of
juvenileosteochondrosis of the spine, and
is more commonly called Scheuermann's
disease. It is found mostly in teenagers
and presents a significantly worse
deformity than postural kyphosis.

Congenital kyphosis
can result in infants whose spinal column has not
developed correctly in the womb. Vertebrae may
be malformed or fused together and can cause
further progressive kyphosis as the child develops.
Surgical treatment may be necessary at a very
early stage and can help maintain a normal curve
in coordination with consistent follow-ups to
monitor changes. However, the decision to carry
out the procedure can be very difficult due to the
potential risks to the child. A congenital kyphosis
can also suddenly appear in teenage years, more
commonly in children with cerebral palsy and other
neurological disorders.

Nutritional kyphosis
can result from nutritional
deficiencies, especially during
childhood, such as vitamin D
deficiency (producingrickets),
which softens bones and results
in curving of the spine and limbs
under the child's body weight.

Decreased lung capacity
Disabling back pain
Neurological symptoms
including leg weakness or
Round back deformity

medication for pain
physical therapy (to help build strength in
the core and back muscles)
yoga (to increase body awareness and build
strength, flexibility, and range of motion)
weight loss
braces (in children and teens)
chiropractic treatments (to correct the
spinal alignment)
surgery (in severe cases)

Kyphologic brace


refers to a
child who has
curvature of
the spinal


Muscular dystrophies
Ehlers-Danlos syndrome
Larsen syndrome
Strudwick syndrome
Williams syndrome
Benign juvenile lordosis
Becker muscular dystrophy
Cohen syndrome

Postural Lordosis: comes from
being over-weight and lack of
muscle conditioning in the
stomach and back muscles. When
a person carries too much weight
in the front (stomach area) it pulls
the back forward. When the
stomach and back muscles are
weak, they cannot support the
spine and the pull from the weight

Congenital / Traumatic Lordosis:

trauma or injury to the connecting links of the
spine (pars) can cause them to break
(fracture) causing pain in the low spine. In
children these often occur from sports injuries.
This can also be seen in children hit by a car or
with falls from high areas.. With repetitive
activities stressing this weak links, they can
develop a spondylolysis (break in bone
connection). Whatever the reason the break
occurs it needs rest and restricted movement
to heal.. This can lead to pain, numbness,
tingling, weakness, and dysfunction of the legs

Post-surgical Laminectomy
laminectomy is a surgical procedure where
parts of the vertebrae (spinal bones) are
removed to give access to the spinal cord or
nerve roots. When this is done over several
levels in the spine, it can cause the spine to be
unstable and increase the normal curve to a
hyperlordotic (overly curved) position. This is
not a common problem in adults and more
routinely is seen occurring in children with
spinal cord tumors following surgery to remove
the tumor.

Medical management:

Taken as needed for occasional

back discomforts :
acetaminophen (Tylenol)
ibuprofen (Advil)
Naprosyn (Aleve).