Handout Orthopedic Nursing Scoliosis

Scoliosis - two or more vertebrae are fused together,
using bone grafts and metal rods and screws

 /sko-lee-oh-sus/ Greek word =crooked
 sideways curve of your backbone, or spine.
 often S- or C-shaped.
 Scoliosis is most common in growth spurts. Spinal fusion is used to treat:
 Girls prone
 Hereditary • Injuries to spinal vertebrae
• Protrusion and degeneration of the
Cause: cushioning disk between vertebrae
• Nonstructural, which is when the spine is (sometimes called slipped disk or herniated
structurally normal and the curve is disk)
temporary. • Abnormal curvatures of the spine (such as
• Structural, which is when the spine has a scoliosis or kyphosis)
fixed curve. The cause could be a disease, • Weak or unstable spine caused by infections
injury, infection, or birth defect. or tumors
Signs: Spinal fusion

*Idiopathic scoliosis can go unnoticed in a child  eliminates motion between vertebral
because it is rarely painful in the formative segments, may cause pain.
years.Parents should watch for the following warning  stops the progress of spinal deformity, such
signs of scoliosis when their child is about 8 years of as scoliosis.
age:  will take away some spinal flexibility
• Uneven shoulders Technique:
• Prominent shoulder blade or shoulder
blades Bone Grafting
• Uneven waist  most commonly used material to help
• Elevated hips promote fusion of the vertebrae.
• Leaning to one side  small pieces of bone are placed into the
space between the vertebrae to be fused
Diagnosis:  larger solid pieces are used to provide
 medical and family history immediate structural support.
 The bone is either supplied by the patient
 physical exam
(autogenous bone) or harvested from other
 x ray individuals (allograft bone).
-lets the doctor measure the curve in
degrees (such as 25 degrees) and see its
*Autogenous bone is generally better at promoting
location, shape, and pattern.
fusion, but it requires extra surgery to remove bone
from the patient's hip.
Treatment for scoliosis is based on:
 The person's age Immobilization
 How much more he or she is likely to grow
 The degree and pattern of the curve
 Bones are immobile with metal rods and
screws
 The type of scoliosis.
1. Observation  External bracing or casting may also be
 check every 4 to 6 months to see if the used (can be both)
curve is getting better or worse
 Used for those who have a curve of less The 4 Components Orthopaedic Evaluation
than 25 degrees and are still growing.
1. Medical history - information about pt’s
2. Bracing general health and symptoms
 The person is still growing and has a curve
of more than 25 to 30 degrees. 2. Physical examination - to assess the
stability, strength, alignment and motion of your
 The person is still growing and has a curve back, as well as a neurologic evaluation
between 20 and 29 degrees that is getting
worse.
3. Diagnostic tests (radiography)
 The person has at least 2 years of growth
remaining and has a curve that is between (X-rays), which may be
20 and 29 degrees. If a girl, she should not obtained to evaluate the bones and
have started having her monthly periods yet. structure of your spine
3. Surgery
MRI (magnetic resonance
imaging) to provide more detailed
 when the person is still growing information about the spine and
 the curve is more than 45 degrees uses no radiation to
 the curve is getting worse create images.
Spinal Fusion
Myelography uses X-ray
imaging and an injected dye to Recovery at Home
define bony and soft-tissue
structures affecting the nerve root  Arrange for transportation home that will
allow the pt. to ride in a leaning back or lying
CT (computed tomography) may down position
also be arranged; CT provides
details about the bones  Pt. may do as much for himself as you can
and soft tissues not seen on as long as you maintain a balanced position
regular X-rays of your spine
 Pt. should not stay in bed during the day

4. Discussion - findings of the physical
examination and diagnostic evaluation and the  Teach the pt. not hesitate to ask for help
treatment for pt’s condition from your family members or friends if it is
needed
Pre-OP care
Wound Care
1. Medication- stop taking certain medicine  stitches(sutures) or staples will be removed
 may interfere with or affect the results of approximately 2 weeks after surgery
surgery
 may cause bleeding  If the wound is clean and dry, no bandage is
 may interfere with the effects of your needed.
anesthesia
 aspirin and nonsteroidal anti-inflammatory  If drainage continues after you are home,
drugs the wound should be covered with a
bandage and a call made to pt’s surgeon
2. Donating Blood
Diet
 blood loss may occur during surgery Some loss of appetite is common. Eating well-
 doctor may prescribe an iron supplement balanced meals and drinking plenty of fluids are
to help build up your blood before surgery important
Advance Nursing Plan: Activity

Loss of energy is frequently experienced after major
 The pt. will be able to walk after surgery surgery, but this improves over time.
 Arrange for some help with washing, Initially, pt should only participate in walking
dressing, and household activities, such as
cleaning, laundry, and shopping, for a few Later, swim or use an exercise bike or treadmill to
days after your return home improve pt’s general physical condition
 Do not drive a car for a period of time after Avoiding Problems after Surgery
surgery.
Warning signs of possible blood clots include the
Nursing Considerations: following:
1. Immediate complications
 urinary retention • Swelling in the calf, ankle or foot
 temporary decreased or absent intestinal • Tenderness or redness, which may extend
function above or below the knee
2. Major complications • Pain in the calf
 Heart attack
 Stroke *a blood clot may travel through the blood stream
 Infection & Blood clots- first few weeks after and may settle in your lungs (Pulmonary embolism)
surgery Symptoms:
 Recurrent disk herniations sudden chest pain and shortness of breath
or coughing
 nerve damage can result in pain and
prolonged recovery time
Infection following spine surgery occurs very rarely
Rehabilitation Warning signs of infection include:
 Pain medication will be given regularly, or
PCA • Redness, tenderness, and swelling around
the wound edges
 The fused spine must be kept in proper
alignment • Drainage from the wound
• Pain or tenderness
 Turn frequently using a "log rolling"
technique-move the entire body as a unit, • Shaking chills
avoiding twisting of the spine. • Elevated temperature, usually above 100°F
if taken with an oral thermometer
 Discharged from the hospital with a back
brace or cast.
After Recovery
 Weight reduction Program
 Exercise programs have not been shown

to keep scoliosis from getting worse.
 Weight-bearing exercise, such as

walking, running, soccer, and
gymnastics, helps keep bones strong
Alternative Treatments
So far, the following treatments have not been

shown to keep curves from getting worse in
scoliosis:
>Chiropractic treatment
>Electrical stimulation
>Nutritional supplements
>Exercise

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Scoliosis - two or more vertebrae are fused together,

using bone grafts and metal rods and screws

Signs: Spinal fusion

 Pt. should not stay in bed during the day

Advance Nursing Plan: Activity

 Exercise programs have not been shown

 Weight-bearing exercise, such as

So far, the following treatments have not been

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