Scoliosis

NORMAL SPINE

CURVE PATTERNS

A normal spine, when viewed from behind, appears straight. However, a spine affected by scoliosis shows evidence of a lateral, or side-by-side curvature, with the spine looking like an "S" or "C" and a rotation of the back bones (vertebrae), giving the appearance that the person is leaning to one side. Thus, the name scoliosis is derived from the Ancient Greek word skolios meaning crooked. The Scoliosis Research Society defines scoliosis as a curvature of the spine measuring 10 degrees or greater. Scoliosis is a type of spinal deformity and should not be confused with poor posture. Spinal curvature from scoliosis may occur on the right or left side of the spine, or on both sides in different sections. Both the thoracic (mid) and lumbar (lower) spine may be affected by scoliosis. Incidence Scoliosis is about two times more common in girls than boys. It can be seen at any age, but it is most common in those over 10 years of age. Scoliosis is hereditary in that people with scoliosis are more likely to have children with scoliosis; however, there is no correlation between the severities of the curve from one generation to the next. In over 80 percent of cases, the cause of scoliosis is unknown a condition called idiopathic scoliosis. 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 life-threatening.

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 to scoliosis. 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 of scoliosis by addressing the underlying condition. The term nonstructural scoliosis has also been used to describe cases involving a side to side 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 Marfan s 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 structural scoliosis 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 (congenital scoliosis) may experience rapid worsening of the curve. Three Types of Scoliosis Congenital. This type of scoliosis occurs during fetal development. It is often caused by one of the following: o Failure of the vertebrae to form normally o Absence of vertebrae o Partially formed vertebrae o Lack of separation of the vertebrae Neuromuscular. This type of scoliosis is associated with many neurological conditions,

especially in those children who do not walk, such as the following: o Cerebral palsy o Spina bifida o Muscular dystrophy o Paralytic conditions o Spinal cord tumors o Neurofibromatosis (This is a genetic condition that affects the peripheral nerves that causes changes to occur in the skin, called caf-au-lait spots.) Idiopathic. The cause of this type of scoliosis is unknown. There are three types of idiopathic scoliosis: o Infantile (This type of scoliosis occurs from birth to age 3. The curve of the vertebrae is to the left and it is more commonly seen in boys. Typically, the curve resolves as the child grows.) o Juvenile (Juvenile scoliosis occurs in children between ages 3 and 10.) o Adolescent (This type of scoliosis occurs in children between ages 10 and 18. This is the most common type of scoliosis and is more commonly seen in girls.) Diagnosis for Scoliosis In addition to a complete medical history and physical examination, X-rays (a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film) are the primary diagnostic tool for scoliosis. In establishing a diagnosis of scoliosis, the physician measures the degree of spinal curvature on the X-ray. The following other diagnostic procedures may be performed for nonidiopathic curvatures, atypical curve patterns, or congenital scoliosis: Magnetic resonance imaging (MRI). This diagnostic procedure uses a combination of large magnets and a computer to produce detailed images of organs and structures within the body. Computed tomography (CT) scan. This diagnostic imaging procedure uses a combination of X-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays. Early detection of scoliosis is most important for successful treatment. Pediatricians or family physicians, and even some school programs, routinely look for signs that scoliosis may be present. Treatment for scoliosis The goal of treatment is to stop the progression of the curve and prevent deformity. Treatment may include: Observation and repeated examinations. Observation and repeated examinations may be necessary to determine if the spine is continuing to curve, and are used when a person has a curve of less than 25 degrees and is still growing. Progression of the curve depends upon the amount of skeletal growth, or the skeletal maturity of the child. Curve progression slows down or stops after the child reaches puberty. Bracing. Bracing may be used when the curve measures more than 25 to 30 degrees on an X-ray, but skeletal growth remains. It may also be necessary if a person is growing and has a curve between 20 and 29 degrees that isn't improving. The type of brace and the amount

of time spent in the brace will depend on your child's condition. Surgery. Surgery may be recommended when the curve measures 45 degrees or more on an X-ray and bracing isn't successful in slowing down the progression of the curve when a person is still growing. According to the National Institute of Arthritis and Musculoskeletal and Skin Disorders, there is no scientific evidence to show that other methods for treating scoliosis (for example, chiropractic manipulation, electrical stimulation, nutritional supplementation, and exercise) prevent the progression of the disease. If left untreated, scoliosis can cause problems with heart and lung function. Main Duties and Responsibilities Act as principal liaison for the effective admission planning and eventual discharge of children with spinal disorders including trauma and adult patients with spinal deformity. Develop and implement care pathways regarding pre operative preparation and management of inpatients. Provide written and verbal advice for patients/families. Run nurse-led clinics for children and adult patients with scoliosis in conjunction with nominated consultants. Participate in out-patients consultations. Provide specialist education and training for ward/dept nurses, other health professionals and students within the NUH. Providing Telephone advice service for patients/families and ward/dept nurses. Undertake/participate in clinical audit in the field of scoliosis.