Scoliosis

A lateral curvature of the spine, may be found in thoracic, lumbar, or thoracolumbar spinal segment. The curve may be convex to the right (more common in lumbar curves) or to the left (more common in lumbar curves). Rotation of the vertebral column around its axis occurs and may cause rib cage deformity. It is often associated with kyposis (humpback) and lordocis (swayback).

Etiology And Pathophysiology 1. Idiopathic scoliosis exact etiology is unknown. Accounts for 65% of cases. Possible causes include genetic factors, vertebral growth abnormality. Classified into three groups based on age at time of diagnosis. o Infantile birth to age 3. o Juvenile presentation between age 11 and 17. 2. Congenital scoliosis exact etiology unknown; represented as malformation of one or more vertebral bodies that results in asymmetric growth. o Type I failure of vertebral body formation e.g. isolated hemivertebra, wedged vertebra, multiple wedged vertebrae, and multiple hemivertebrae. o Type II failure of segmentation e.g. unilateral unsegmented bar, bilateral block vertebra. o Commonly associated with other congenital anomalies. 3. Paralytic or musculoskeletal scoliosis develops several months after symmetrical paralysis of the trunk muscles from polio, cerebral palsy, or muscular dystrophy. 4. Neuromascular scoliosis child has a definite neuromascular condition that directly contributes to the deformity. 5. Additional but less common causes of scoliosis are osteopathic conditions, such as fractures, bone disease, arthritic conditions, and infections. 6. Miscellaneous factors that can cause scoliosis include spinal irradiation, endocrine disoders, postthoracotomy, and nerve root irritation. 7. As the deformity progresses, changes in the thoracic cage increase. Respiratory and cardiovascular compromise can occur in cases of severe progression. Signs and symptoms Patients having reached skeletal maturity are less likely to have a worsening case. Some severe cases of scoliosis can lead to diminishing lung capacity, putting pressure on the heart, and restricting physical activities. The signs of scoliosis can include:

Uneven musculature on one side of the spine A rib prominence and/or a prominent shoulder blade, caused by rotation of the ribcage in thoracic scoliosis

Uneven hips/leg lengths Slow nerve action (in some cases) Poor posture, uneven shoulder height. One hip more prominent than the other. Scapular prominence. Uneven waist line or hemline Spinal 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.

he basic Pathophysiology of Scoliosis Scoliosis is an abnormal sideways curvature of the spine that is typically found in children and adolescents. In most cases, scoliosis is painless. However, it can become gradually more severe if left untreated, resulting in chronic back pain. In young children, severe cases can cause deformities, impair development and be lifethreatening. In most cases, scoliosis is painless and develops gradually. It often worsens during growth spurts in children and teens. Scoliosis patients who wear a back brace over an extended period of time can usually prevent further curvature of the spine. The cause of most cases of scoliosis cases is unknown (idiopathic). Suspected causes of scoliosis include connective tissue disorders, muscle disorders, hormonal imbalance and abnormality of the nervous system. Spinal cord and brainstem abnormalities may also contribute toscoliosis. The condition can also be hereditary. Physicians classify the causes of scoliosis curves into one of two categories:

Nonstructural scoliosis. Also known as 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 ofscoliosis by addressing the underlying condition. The term nonstructural scoliosis has also been used to describe cases involving a sidetoside curvature. Structural scoliosis. This is a fixed curve that is treated

individually according to its cause. Some cases of structural scoliosis are the result of disease, such as the inherited connective tissue disorder known as Marfans syndrome. In other cases, the curve occurs on its own. Other causes include neuromuscular diseases (such as cerebral palsy, poliomyelitis or muscular dystrophy), birth defects, injury, infection, tumors, metabolic diseases, rheumatic diseases or unknown factors. The term structuralscoliosis has also been used to describe cases involving a twisting of the spine in three dimensions rather than a sideways curvature. Certain factors are known to increase the risk for scoliosis, as well as the risk that the disorder will become more severe. These include:

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. 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 (congential scoliosis) may experience rapid worsening of the curve.

Pathophysiology: Idiopathic:Much has been written regarding the potential influence of melatonin on the development of idiopathic scoliosis. This has largely originated from studies in which the pineal gland was removed in chickens and scoliosis developed. These same studies suggested that the melatonin deficiency following pinealectomy might be the underlying reason for the development of scoliosis. Bagnall and his coauthors studied pinealectomized chickens to which they administered therapeutic doses of melatonin. They were unable to demonstrate any ability of the melatonin to prevent the development of scoliosis. It is fair to say that no final answer is yet available. Some authors have suggested that a posterior column lesion within the central nervous system might be

present in patients who have idiopathic scoliosis. Such central nervous system dysfunction was hypothesized to be manifested as decreased vibratory sensation. McInnes and her fellow researchers later pointed out that the vibration device used in earlier studies (a Bio-Thesiometer) did not demonstrate sufficient reliability characteristics to allow valid conclusions. This line of research might be attractive to those who feel that a postural disturbance is the root cause of scoliosis. Neuromuscular:The pathophysiology is not well understood. It seems logical to assume that scoliosis in these conditions is caused by muscle weakness, but this conclusion is difficult to support because some conditions are accompanied by spasticity and others by flaccidity. Furthermore, no consistent pattern of scoliosis is associated with a particular pattern of weakness. PATHOPHYSIOLOGY The vertebra turn toward the convex side and spinous processes rotate toward the concave side in the area of the major curve. As the vertebra rotate, they push the ribs on the convex side posteriorly and at the same time, crowd the ribs on the concave side together as well as push them anteriorly. The posterior displaced ribs cause the characteristic hump in the back with forward flexion. Young girls with scoliosis would often complain of unequal breasts. This is due to recess of the chest wall on the convex side of the curve. Disc space is narrower on the concave side and wider on the convex side. The vertebra may become wedged on the concave side in serve cases. The lamina and pedicles are also shorter. Vertebral canal is narrower on the concave side. Spinal cord compression is rare even in serve cases.

Physiological changes include: Decrease in lung vital capacity due to a compressed intrathoracic cavity on the convex side. With left scoliosis, the heart is displaced downward; and in conjunction with intrapulmonary obstruction, this can result in right cardiac hypertrophy.

NURSING MANAGEMENT Pre-Op Nursing Considerations for Scoliosis: Health Teachings and orientation to the patient and relatives concerning scoliosis and its treatment procedures that they can choose from. Post-Op Nursing Considerations for Scoliosis: Monitor for s/s to determine if there are any potential complications Promote proper body alignment Promote pulmonary ventilation by breathing and coughing exercises. Monitor fluid and electrolyte balance to assess dehydration. Provide pain relief measures as necessary. Discharge Planning and Home Care - post-op for Scoliosis: Instruct the patient and family about the various aspects of care that can be done for scoliosis patients at home. Encourage to patient ventilate fears and body image concerns to his/her relatives and love ones. Encourage adherence to follow-up regimen