Scoliosis is actually a derivative of the ancient Greek term skoliosis "obliquity, bending" (Online Etymology Dictionary)
Scoliosis is an abnormal curvature of the spine looking somewhat like the letter C. Or S. And affects approximately 7 million people in the United States (Scoliosis Research Society website). It is most common during childhood and particularly in girls.
Scoliosis is called different names depending on the stage of development that it hits.
In children aged 3-4, it is called infantile scoliosis
In children age 4-10, it is called juvenile scoliosis.
In adolescents (or kids age 11 -- 18) naturally it is called adolescent scoliosis.
Scoliosis most affects females and the curving generally increases during the growth spurt. It is most similar to Kyphoscoliosis which is another abnormal curvature of the spine but Kyphoscoliosis or Kyphosis (for short) is distinct form scoliosis in that its representation is a hunched over, slouched posture that, contrary to scoliosis, is rare at birth (PubMed. Health. Kyphosis )
2). Etiology (explore all factors that may be involved in the development of the disease)
Causes of the disease are approximately 65% of the time unknown. This is called idiopathic scoliosis. The closest speculation is that genes are involved although causes are most likely multifactorial. What these factors are is debated amongst scientists. Various genes are involved in transmission, one of these genes being the CHD7 (Ogilvie JW, Braun J, Argyle V, Nelson L, Meade M, Ward K (2006.)
There are two types of scoliosis that are, however, known and these are:
Congenital scoliosis: A form of scoliosis that is present at birth and occurs when the baby's ribs or spine bones do not form properly in the 3rd or 6th weeks of in utero. Its percentage is 15%.
Neuromuscular scoliosis (10% chance of occurring): Scoliosis that is caused by a nervous system problem that affects the muscles, such as cerebral palsy, muscular dystrophy, spine bifida, physical trauma and polio. It often -- although not always -- occurs during adolescence (11- 18 years) as for instance with tethered spinal cord syndrome and worsens during adolescent growth spurt (Agabegi & Agabegi, 2008).
Another lesser known cause of scoliosis is that which comes from the condition called Chiari malformation which originates from a malformation of the brain. This rare form of scoliosis causes the most harm and is the most difficult to treat as is congenital and neuromuscular scoliosis. Idiopathic scoliosis, on the other hand, is more vulnerable to treatment and physiology harmless (JAMA.)
3). Clinical manifestations (subjective and objective signs / symptoms)
Scoliosis usually has no symptoms. The signs otherwise are clear: the curvature of the spine.
Some symptoms may include the following:
Backache or low-back pain
A tired feeling in the spine after sitting or standing for a long time
Uneven hips or shoulders (one shoulder may be higher than the other)
The spine curves more to one side than to the other.
Complications of scoliosis usually include:
Breathing problems (in severe scoliosis)
Low back pain
Persistent pain if there is wear and tear of the spine bones
Spinal infection after surgery
Spine or nerve damage from an uncorrected curve or spinal surgery
Uneven arms, hips, or leg length.
In some cases, slow nerve action
Most severe cases of scoliosis can actually be life-threatening since they put pressure on the lungs and can adversely affect breathing
4). Diagnostic tests (enumerate and explain them (laboratory, radiology etc.), including preparation and post-test observations)
Routine scoliosis screening has now become a fixture in many public schools usually during the Middle or Junior years.
Genetic testing for Adolescent Idiographic Scoliosis launched in 2009 is still being investigated.
For those who have not received screening and where scoliosis is suspected, there will be a physical examination where the individual will be asked to bend over -- called the Adams forward bend test - in order that nurse can examine the spine. X-rays of the spine are also conducted since the spine may actually appear worse than seen by the naked eye.
Other signs that the nurse will look out for will be:
The skin for Cafe au lait spots (i.e pigmented marks)
The feet for cavovarus deformity (where the sole of the foot is hollow when placed on floor)
She will test the abdominal reflexes
She will test muscle tone for spasticity.
Other tests may include:
Spinal curve measurement (scoliometer screening) where the person's gait is assessed and test is conducted for possible other abnormalities (such s spina bifida)
MRI of the spine (PubMed Health; online)
5). All aspects of the management of the pathology:
Not all patients with scoliosis are given treatment. Treatment depends on the following conditions:
The cause of scoliosis
Where the curve is in the patient's spine
Significance of the curve
If the patient's body is still growing
Most patients with idiopathic scoliosis do not need or receive treatment. People with scoliosis, regardless of whether or not they receive treatment, should be monitored on development of their spine every 6 months.
Treatment includes braces and sometimes surgery
Children who are still growing are often treated with a back brace which controls the position of the spine and prevents it from further curving. The back brace is made precisely to fit the pattern of the curve and is adjusted as the child grows and is usually given only to children over 10. Braces do not work for patients with congenital or neuromuscular scoliosis. .
Scoliosis surgery is done when the spine is significantly bent and it involves straightening the curve as much as possible. During surgery, the spine bones are held in place with one or two metal rods, which are held down with hooks and screws until the bones straighten out; a brace is worn for a while fowling surgery for the same purpose. Casting may alternatively be employed.
The surgical procedure is often done with a cut through the back, belly area, or beneath the ribs. There are 2 kinds:
Anterior fusion: where surgery is made through an incision at the side of the chest wall.
Posterior fusion: where incision is made on the back.
Two surgical procedures are the following:
Spinal fusion - a common treatment that is alternatively employed where bone (either harvested from elsewhere in the body or donated) is grafted to the vertebrae so that as the spinal column grows it synthesizes and becomes rigid.
Thoracoplasty - a less common option where a thoracic curve is used to straighten the spine. Bone grafts are used from the pelvis to replace and cover the rib hump.
In all cases, the back brace afterwards is worn until the doctor decides it no longer necessary.
Reaction to Treatment
People with mild sclerosis usually react better to surgery and the brace than others. One of the effects, however, may be back pain as the person reaches elderly age.
The prognosis for those with neuromuscular or congenital scoliosis varies. These children usually have another serious disorder such as cerebral palsy so the goal usually is just to have them sit straight in a wheelchair. The more entrenched the scoliosis, the more difficult it is to treat and, indeed, congenital scoliosis usually requires numerous visits.
6). Find impairment for 4 Needs of Virginia Henderson and 4 basic cares (intervention in relation to the pathology and unmet needs).
Since scoliosis treatment may be psychologically embarrassing, many patients profit from emotional support and counseling.
Patients are also given physical therapy in order to help explain the treatments and to make sure the brace fits correctly as well as to help them resume their daily lives.
The nurse and OT or PT shows the patient various self-care strategies for daily life (such as for dressing, bathing, grooming, personal hygiene, and feeding). These…