Saturday, August 20, 2016

Scoliosis

A lateral curvature of the spine. It usually consists of two curves, the original abnormal curve and a compensatory curve in the opposite direction. Scoliosis may be functional, structural, or idiopathic. Functional or postural scoliosis usually occurs as a result of a discrepancy in leg length and corrects when the patient bends toward the convex side. Structural scoliosis is related to vertebral bone deformities and thus does not correct with posture changes. Idiopathic scoliosis (the most common kind) may be transmitted as an autosomal dominant or multifactorial trait. scoliotic.





INCIDENCE
Scoliosis affects approx. 7 million people in the U.S. A curve of 10° affects approx. 3% of all individuals. Curves less than 20° are approx. equal in males and females. Scoliosis is most common during late childhood, esp. in girls.

SYMPTOMS AND SIGNS
Scoliosis rarely produces any symptoms until it is well established; then backache, fatigue, and dyspnea from ventilatory compromise may occur.

DIAGNOSIS
Diagnosis is based on physical examination, anteroposterior and lateral spinal x-rays, and by using the Cobb angle to measure the angle of curvature.

TREATMENT
Scoliosis may be treated with a thoracolumbar orthosis to straighten the abnormal spinal curvature and prevent it from twisting, or, when the Cobb angle exceeds 50°, with corrective orthopedic surgery, e.g., the placement of a supportive rod along the spine or spinal fusion.

PATIENT CARE
Muscle strengthening exercises should be done daily when the patient is in and out of the brace. Follow-up assessment and brace adjustment should be done periodically. As the skeleton matures, brace wear is gradually reduced to nighttime use only. Surgery is indicated when scoliosis progresses despite bracing. Postoperative visits are required for several months to monitor correction stability. Provisions are made to assist the adolescent and family to meet the psychosocial needs associated with the illness. The patient and family are taught about treatment management (cast-care, brace-use, traction, electrical stimulation, or surgery), exercises, activity level, skin care, prevention of complications, and breathing exercises. When necessary, preoperative teaching is provided, including preanesthesia breathing exercises, postoperative use of an incentive spirometer, surgical pain management, and prevention of thromboembolic or other complications. Following surgery, all general patient care concerns apply.

Upon discharge, home-health care may be needed, and the school-age child or adolescent will require education in the home until he or she is able to return to school. Activity and activity limitations are explained, and diversional activities suggested. The patient is encouraged to provide self-care as much as possible. Wearing one's own clothes, washing and styling one's own hair, and applying make-up improve morale. Educational and support resources are discussed with the patient and family. Pediatricians, pediatric nurse practitioners, school nurses, and other health professionals caring for children should include screening for scoliosis during physical examinations.

Cicatricial scoliosis
Scoliosis due to fibrous scar tissue contraction resulting from necrosis.

Congenital scoliosis
Scoliosis present at birth, usually the result of defective embryonic development of the spine.

Coxitic scoliosis
Scoliosis in the lumbar spine caused by tilting of the pelvis caused by a hip disorder.

Empyematic scoliosis
Scoliosis following empyema and retraction of one side of the chest.

Functional scoliosis
Scoliosis caused not by actual spinal deformity but by another condition such as unequal leg lengths. The curve reduces when the other condition is ameliorated.

Habit scoliosis
Scoliosis due to habitually assumed improper posture or position.

Inflammatory scoliosis
Scoliosis caused by infection or inflammation near the spine, resulting in local muscle spasm.

Ischiatic scoliosis
Scoliosis due to hip disease.

Myopathic scoliosis
Scoliosis due to weakening of the spinal muscles.

Neuropathic scoliosis
Structural scoliosis caused by congenital or acquired neurological disorders.

Ocular scoliosis
Scoliosis caused by tilting the head to compensate for visual defects or for extraocular muscle imbalance.

Osteopathic scoliosis
Scoliosis caused by bony deformity of the spine.
SEE: structural scoliosis

Paralytic scoliosis
Scoliosis due to paralysis of muscles.

Protective scoliosis
Scoliosis of the lumbar spine, usually away from the side of pathology. The body is attempting to move a nerve root away from a bulging intervertebral disk herniation.

Rachitic scoliosis
Scoliosis due to rickets.

Sciatic scoliosis
Scoliosis caused by the patient’s assumption of a laterally bent posture to reduce symptoms of sciatica.

Static scoliosis
Scoliosis due to a difference in the length of the legs.

Structural scoliosis
An irreversible scoliosis that has a fixed rotation. The vertebral bodies rotate toward the convexity of the curve; the rotation results in a posterior rib hump in the thoracic region on the convex side of the curve. In structural scoliosis, the spine does not straighten when the patient bends.