scoliosis
DESCRIPTION
ScoliosisTRANSCRIPT
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