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Scoliosis
1. Hebron University
Faculty of Nursing
Scoliosis
Prepared by: Malik Manasrah
Instructor: Dr.Hussein jabareen
2. Scoliosis
What is it?
Demographics
What Causes It?
Natural history of scoliosis?
Treatment
conclusion
3.
4. What is scoliosis?
Lateral curvature of the spine >10º
accompanied by vertebral rotation
Can be seen as a C curve or S-curve
5.
6. Demographics
0.1% have a curve greater than 40º
Girls are more often affected than boys
Those with a curve of 30 º are generally girls,
out numbering boys 10 to 1
Generally progresses during “Growth Spurts”
Adolescents are more routinely tested for
scoliosis
7. What Causes It?
Musculoskeletal disorders
Congenital Abnormalities (Occurring at
birth/birth defect )
Neuromuscular Discrepancies (Nerve &
muscle damage in spine and surrounding
areas)
Degenerative Means (Bone erosion or
ruptured intervertebral disk )
Idiopathic (No known reason/cause,
could be hereditary)
8. Natural history of scoliosis
Of adolescents diagnosed with scoliosis, only
10% have curve progression requiring medical
intervention
Three main determinants of curve progression
are:
(1) Patient gender
(2) Future growth potential
(3) Curve magnitude at time of diagnosis
9. How it diagnosed?
Visual examination of gait, posture, leg length, and lateral curves
of spine
Can also be detected accidentally by radiographs
CT (Bone abnormalities and derangements, Bone tumors)
MRI (Nerve damage, Soft tissue damage , Disk abnormalities)
Scoliometer
Adam’s forward bend test
10. Scoliometer
An inclinometer (Scoliometer) measures distortions of the torso.
•The patient bends over , ar ms
dangling and palms pr essed
together, until a curve can be
obser ved in the upper back (thor acic
ar ea).
•The Scoliometer is placed on the
back and measur es the apex (the
highest point) of the upper back
curve.
•The patient continues bending until
the curve can be seen in the lower
back (lumbar ar ea). The apex of
this cur ve is also measur ed.
11. Adam’s forward bend test
For this test, the patient is asked to lean forward with his
or her feet together and bend 90 degrees at the waist. The
examiner can then easily view from this angle any
asymmetry of the trunk or any abnormal spinal
curvatures.
12. Screening (signs):
Shoulders are different heights – one shoulder blade is
more prominent than the other
Head is not centered directly above the pelvis
Appearance of a raised, prominent hip
Rib cages are at different heights
Changes in look or texture of skin overlying the spine
(dimples, hairy patches, color changes)
Leaning of entire body to one side
13. Treatment:
10 º Curve or Less
This curvature is considered normal
No action is taken
Follow up appointments are prescribed to
monitor curve
Usually every 3-6 months, at the physician’s
discretion
14. Treatment
10 º- 25 º Curve
Sometimes no treatment, if no progression
Begins with simple orthotics (very effective)
Daytime/nighttime braces
Shoe lifts (leg length discrepancy)
Stretches, exercises
15. Braces
Made of polypropylene
Contoured to size & shape
of body
Curved to oppose specific points of
Scoliosis curvature
Flexible & comfortable
Worn under clothing
Nighttime & Daytime
MUST be worn faithfully
16. Shoe Lifts
Used for leg length
discrepancies
Worn in regular shoes
Places opposing
pressure on scoliosis
curvature
Must be worn during
every scoliosis radiograph
17. Treatment:
25 º- 35 º Curve
Day & night brace worn 20+ hrs/day
Shoe lifts as well in certain cases
Stretches & exercises to loosen muscles and
relieve pain if present
18. Treatment:
45 º+ Curve
Almost always treated with surgery
Bone grafts
Hardware (metal splints)
Still requires brace to be worn post-op
Causes growth to stop
Can cause nerve damage, infection, and
other problems
19. Left Untreated
If progressing, can worsen up to 70 º+ curve
Places pressure on vital organs
Causes cardiac and respiratory problems
Can eventually become untreatable
20. Surgical Treatment for Scoliosis
Curves in growing children greater than 40 º
require a spinal fusion
Skeletally mature patients can be observed until
their curves reach 50 º
Posterior spinal fusion is best choice for thoracic
curves
Anterior spinal fusion is best treatment for
thoracolumbar and lumbar curves
21. Surgical Treatment for Scoliosis
• Spinal surgery with instrumentation
significantly corrects deformity &
usually stops curve progression
• Surgery is accompanied by spinal
cord monitoring using somato-
sensory .
(risk of neurologic injury is 1/7000)
22. Referral Guidelines & Treatment
Curve
(degrees) Risser grade X-ray/refer Treatment
10 to 19 0 to 1 Every 6 months/no Observe
10 to 19 2 to 4 Every 6 months/no Observe
20 to 29 0 to 1 Every 6 Brace after 25
months/yes degrees
20 to 29 2 to 4 Every 6 Observe or brace
months/yes
29 to 40 0 to 1 Refer Brace
29 to 40 2 to 4 Refer Brace
>40 0 to 4 Refer Surgery †
23. Risk of Curve Progression
Curve (degree) Growth potential (Risser grade) Risk
10 to 19 Limited (2 to 4) Low
10 to 19 High (0 to 1) Moderate
20 to 29 Limited (2 to 4) Low/mod
20 to 29 High (0 to 1) High
>29 Limited (2 to 4) High
>29 High (0 to 1) Very high
.
*—Low risk = 5 to 15 percent; moderate risk = 15 to 40 percent; high
risk = 40 to 70 percent; very high risk = 70 to 90 percent.
24. Conclusions
90% of kids with scoliosis will not require
medical intervention
Girls are much more likely than boys to need
intervention for scoliosis
Bracing can slow progression of many curves and
significantly decrease need for surgery
Spinal fusion surgery is recommended for curves
greater than 45 – 50 degrees
