SCOLIOSISSCOLIOSIS

Three dimensional deformity involving Three dimensional deformity involving rotation of the vertebral bodiesrotation of the vertebral bodies

Causes the rib cage to become misshapenCauses the rib cage to become misshapen Body develops a compensatory curve to Body develops a compensatory curve to

maintain posture and balancemaintain posture and balance Nonstructural scoliosis does not involve Nonstructural scoliosis does not involve

rotational or muscular deformity due to poor rotational or muscular deformity due to poor postureposture

DegreesDegrees

10 to 20 a slight curve10 to 20 a slight curve

More than 40% curve requires surgeryMore than 40% curve requires surgery

More than 80% compromises respiratory More than 80% compromises respiratory function and is considered severefunction and is considered severe

Clinical ManifestationsClinical Manifestations

Visible curve of the spineVisible curve of the spine A rib hump when bending forwardA rib hump when bending forward Asymmetric rib cageAsymmetric rib cage Uneven shoulder or pelvic heights Uneven shoulder or pelvic heights Prominence of scapula or hipProminence of scapula or hip Difference in space between arms and trunk Difference in space between arms and trunk

when standingwhen standing Apparent leg-length discrepancyApparent leg-length discrepancy

Diagnostic EvaluationDiagnostic Evaluation

Routine scoliosis screeningRoutine scoliosis screening

Radiographic examinationRadiographic examination

ManagementManagement

Regular and periodic observation with Regular and periodic observation with radiographic evaluationradiographic evaluation

BracingBracing Spinal fusion surgerySpinal fusion surgery Body image – talk about diagnosis, Body image – talk about diagnosis,

treatment, and feeling about experiencetreatment, and feeling about experience Discuss activities – school or activitiesDiscuss activities – school or activities Notify school nurseNotify school nurse

BracingBracing

Worn 18-23 hours a dayWorn 18-23 hours a day Wear 100% cotton, seamless T-shirtWear 100% cotton, seamless T-shirt Proper skin careProper skin care Clean inside/outside of brace dailyClean inside/outside of brace daily Notify HCP – numbness tingling of arms, Notify HCP – numbness tingling of arms,

leg, feet, cracks or breaks in brace, skin leg, feet, cracks or breaks in brace, skin problems, respiratory problemsproblems, respiratory problems

SURGERYSURGERY

Curvature > 45 degrees Curvature > 45 degrees Spinal fusion with internal instrumentationSpinal fusion with internal instrumentation Delayed as long as possible to allow Delayed as long as possible to allow

maximum skeletal growthmaximum skeletal growth Most common posterior fusionMost common posterior fusion Iliac bone graft can be used for the fusionIliac bone graft can be used for the fusion

Spinal FusionSpinal Fusion

Neurovascular checks – 6 P’sNeurovascular checks – 6 P’s Log rolling every 2 hoursLog rolling every 2 hours Pulmonary toiletingPulmonary toileting Wound careWound care Pain – PCA pumpPain – PCA pump Rule out complications – neurological status Rule out complications – neurological status

lower extremities, fluid status, bleeding, lower extremities, fluid status, bleeding, return of bowel functionreturn of bowel function

Discharge teachingDischarge teaching

Wound careWound care Importance of well balanced dietImportance of well balanced diet Activity restrictions (Orthoplast jacket)Activity restrictions (Orthoplast jacket) Report to HCP – skin breakdown, wound Report to HCP – skin breakdown, wound

infection, numbness/tingling extremities, infection, numbness/tingling extremities, difficulty breathingdifficulty breathing

Provide information about National Scoliosis Provide information about National Scoliosis AssociationsAssociations