This document discusses scoliosis, including its definition as a lateral curvature of the spine greater than 10 degrees with vertebral rotation. It notes that girls are more often affected than boys and curves generally progress during growth spurts. Causes may include musculoskeletal, congenital, neuromuscular, or degenerative issues, or be idiopathic. Treatment depends on curve magnitude and growth potential, ranging from observation for small curves to bracing or exercise for moderate curves to surgery for large curves. Bracing aims to slow progression and decrease need for surgery.

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

4. What is scoliosis?
 Lateral curvature of the spine >10º
accompanied by vertebral rotation
 Can be seen as a C curve or S-curve

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

25. Thank you for your
attention
2010-2011