“Scoliosis” 2.

Congenital scoliosis
 asscociated with abnormalities of the vertebrae such
>abnormal curvature of the spine (S or C shaped) as hemi or fused vertebrae. There is frequent
>bones are rotated slightly making the person waist or association with spina bifida and there may also be a
shoulders appear uneven. paralytic element in such cases.

• Causes: 3. Infantile scoliosis

*congenital  curve develops during the first 3 years without
*Neuromuscular vertebral anomalies. There is often plagiocephaly.
*Idiopathic The curve is often thoracic or thoraco lumbar.
*Osteopathic
4. Adolescent Idiopathic scoliosis
• Common Types of Curves:  can be noticed at the age of 10 or even earlier. The
prognosis depends on the age of onset and on the
level of the curve.

• Classifications:
1. Nonstructural Scoliosis
 structurally normal spine appears curved due to one
or more underlying conditions (eg hip deformity,
defference in leg length, tumor or infection of the
spine and spasm of the spinal muscle associated with
a prolapsed disc)
5. Structural scoliosis
 possible causes are numerous, including the
following:
o Idiopathic
o Congenital
o Neuromuscular (eg. Poliomyelitis, cerebral
palsy, syringomyelia, muscular dystrophy,
amyotonia congenital, Friedreich's ataxia)
o Neurofibromatosis
o Mesenchymal disorder (eg. Marfan's
syndrome, Morquio's syndrome, rheumatoid
arthritis, osteogenesis imperfect, certain
dwarves)
o Trauma ( fractures, irradiation, surgery)
• Types:
 Mild: <25 curvature
- Regular monitoring
- View an X-ray of the spine every 3 mos.
- No bracing or special treatment
  Moderate: 20-40 curvature b.Milwaukee brace: full torso brace has a neck ring with
- Bracing is applied rests for the child and for the back of the head.
 Severe: curve >40 Cobb’s curvature with
kyphosis c. Yamamoto brace
-insertion of metal rods in the pt.’s back and
fusing together several vertebrae is seriously  Physiotherapy: gives more emphasis on posture,
considered. streghtening of muscles and correction of muscle
imbalance.
• Manifestations:  Surgery: SPINAL FUSION- joining of two pieces
>uneven shoulder together. It involves connecting 2 or more vertebrae
>uneven waist with pieces of bone taken from pelvis. Eventually, the
>one hip higher than the vertebrae and the pieces of bone fuse together
other preventing further progression of the curve.
>leaning to one side Instrumentation:
>ribs on one side of the 1. Harrington Procedure
body to stick out farther 2. Cotrel-Dubousset Procedure
than the other side
>unequal gaps between the • Nursing Management
arms and the trunk  Assess for skin irritation.
>back pain  Assess for movement, color and sensation
>spine obviously curve  Teach to aid use use of powder and lotion
 Instruct to use undergarments to reduce friction
 Instruct to loosen brace during meals and for the
• Diagnostic tests:
1st 30 mins after meals.
1. Physical Examination:
(Adam’s Forward Bending Test)
2. X-rays
3. Magnetic Resonance Imaging (MRI)
4. Blood tests
5. Computed Tomography Scan (CT Scan)
6. Sonography
7. Radionuclide bone scan

• Treatment:
 Braces: prevents further
progression of the curve
a.Underarm or low profile brace aka
thoracolumbar orthosis (TLSO)