Scoliosis, Kyphosis, Lordosis

SCOLIOSIS, KYPHOSIS, LORDOSISAbegail S. RegaladoScoliosis is an abnormal curving of the spineis a lateral (toward the side) curvature in the normally straight vertical line of the spine.

SCOLIOSIS ACCORDING TO CURVES:

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 curvature.

Types of Scoliosis that Affect Children

infantile scoliosisjuvenile scoliosisadolescent idiopathic scoliosis

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 deformity.

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 intervention.

Adolescent idiopathic scoliosis (AIS)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 non-operative treatment fails to halt curvature.

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.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.

Risk factors:

Location. 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 ScoliosisBackache or low-back painTired feeling in the spine after sitting or standing for a long timeUneven hips or shoulders (one shoulder may be higher than the other)Spine curves more to one side

AssessmentPoor posture, uneven shoulder height.One hip more prominent than the other.Scapular prominence.Uneven waist line or hemlineSpinal 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 evaluationX-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

Congenital Thoracic Curve

Progressive Curve

Complications:

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 appearanceTherapeutic management treatment plan is determined by the child's age, remaining growth potential, curve pattern and magnitude, anticipated rate of progression, and appearance21EXERCISEtaught 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 medications

Spinal Bracing.

Today plaster jackets are used to treat some cases of infantile scoliosis.

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 warranted.

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 complication.

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 treatment.Adolescent scoliosis may be treated surgically using spinal instrumentation and fusion, when necessary.

The goals of spinalinstrumentation include:stabilization of spinal segmentsdeformity correction within safe parametersenchancing spinal fusion

Nursing managementPrepare 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.

KYPHOSIS

Kyphosis 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 curve.. 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.

Causes:can be congenital (present at birth)aging (especially if you have poor posture)muscle weakness in the upper backScheuermanns disease (occurs in children and has no known cause)arthritis or other bone degeneration diseases

osteoporosis (loss of bone strength due to age)injury to the spineslipped discsscoliosis (spinal curvature)infection in the spinebirth defects, such as spina bifidatumorspolioPagets diseasemuscular dystrophy

Clinical manifestationDifference in shoulder heightThe head bends forward compared to the rest of the bodyDifference in shoulder blade height or positionWhen bending forward, the height of the upper back appears higher than normalTight hamstrings (back thigh) muscles

Types of Kyphosis

Postural kyphosisthe 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 humpScheuermanns kyphosisis 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 kyphosiscan 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 kyphosiscan 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.

Complications:

Decreased lung capacityDisabling back painNeurological symptoms including leg weakness or paralysisRound back deformity

Treatment:

medication for painphysical 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 lossbraces (in children and teens)chiropractic treatments (to correct the spinal alignment)surgery (in severe cases)

Kyphologic brace

LORDOSIS

LORDOSIS refers to a child who has an abnormally inward curvature of the spinal column.

CausesAchondroplasiaMuscular dystrophies Ehlers-Danlos syndrome Larsen syndrome SarcoglycanopathyStrudwick syndrome Williams syndrome Benign juvenile lordosisBecker muscular dystrophy Cohen syndrome TYPES OF LORDOSISPostural 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 causes the spine to curve forward.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 legsPost-surgical Laminectomy Hyperlordosislaminectomy 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). Exercise

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