Hebron UniversityFaculty of Nursing

Scoliosis

Prepared by: Malik Manasrah

Instructor: Dr.Hussein jabareen

Scoliosis What is it? Demographics What Causes It? Natural history of scoliosis? Treatment conclusion

What is scoliosis?

Lateral curvature of the spine >10º accompanied by vertebral rotation

Can be seen as a C curve or S-curve

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

Demographics

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)

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

How it diagnosed?

Visual examination of gait, posture, leg length, and lateral curves of spineCan 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

Scoliometer

•The patient bends over, arms dangling and palms pressed together, until a curve can be observed in the upper back (thoracic area). •The Scoliometer is placed on the back and measures 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 area). The apex of this curve is also measured.

An inclinometer (Scoliometer) measures distortions of the torso.

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.

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

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

Treatment10 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

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

Braces

Used for leg lengthdiscrepancies Worn in regular shoes Places opposingpressure on scoliosiscurvature Must be worn duringevery scoliosis radiograph

Shoe Lifts

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

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

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

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

Surgical Treatment for Scoliosis

• Spinal surgery with instrumentationsignificantly corrects deformity &usually stops curve progression

• Surgery is accompanied by spinalcord monitoring using somato-sensory .(risk of neurologic injury is 1/7000)

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 months/yes

Brace after 25 degrees

20 to 29 2 to 4 Every 6 months/yes

Observe or brace

29 to 40 0 to 1 Refer Brace

29 to 40 2 to 4 Refer Brace

>40 0 to 4 Refer Surgery †

Risk of Curve Progression

Curve (degree) Growth potential (Risser grade) Risk

10 to 19 Limited (2 to 4) Low10 to 19 High (0 to 1) Moderate20 to 29 Limited (2 to 4) Low/mod20 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.

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

Thank you for your attention

2010-2011