• A lateral curvature of the spine, may be found in thoracic, lumbar, or thoracolumbar spinal segment.
  • The curve may be convex to the right (more common in lumbar curves) or to the left (more common in lumbar curves).
  • Rotation of the vertebral column around its axis occurs and may cause rib cage deformity.
  • It is often associated with kyposis (humpback) and lordocis (swayback).

Etiology And Pathophysiology

  1. Idiopathic scoliosis – exact etiology is unknown. Accounts for 65% of cases. Possible causes include genetic factors, vertebral growth abnormality. Classified into three groups based on age at time of diagnosis.
    • Infantile – birth to age 3.
    • Juvenile – presentation between age 11 and 17.
  2. Congenital scoliosis – exact etiology unknown; represented as malformation of one or more vertebral bodies that results in asymmetric growth.
    • Type I – failure of vertebral body formation e.g. isolated hemivertebra, wedged vertebra, multiple wedged vertebrae, and multiple hemivertebrae.
    • Type II – failure of segmentation e.g. unilateral unsegmented bar, bilateral block vertebra.
    • Commonly associated with other congenital anomalies.
  3. Paralytic or musculoskeletal scoliosis – develops several months after symmetrical paralysis of the trunk muscles from polio, cerebral palsy, or muscular dystrophy.
  4. Neuromascular scoliosis – child has a definite neuromascular condition that directly contributes to the deformity.
  5. Additional but less common causes of scoliosis are osteopathic conditions, such as fractures, bone disease, arthritic conditions, and infections.
  6. Miscellaneous factors that can cause scoliosis include spinal irradiation, endocrine disoders, postthoracotomy, and nerve root irritation.
  7. As the deformity progresses, changes in the thoracic cage increase. Respiratory and cardiovascular compromise can occur in cases of severe progression.


  1. Poor posture, uneven shoulder height.
  2. One hip more prominent than the other.
  3. Scapular prominence.
  4. Uneven waist line or hemline
  5. Spinal curve observable or palpable on both upright and bent forward.
  6. Back pain may be present but is not a routine finding in idiopathic scoliosis.
  7. Leg length discrepancy.

Nursing Diagnosis

  • Disturbed body image related to negative feelings about spinal deformity and appearance in brace.
  • Risk for impaired skin integrity related to mechanical irritation to brace.
  • Risk for injury related to postoperative complications.

Diagnostic Evaluation

  1. X-ray of the spine in the upright position, preferably on one long 36-inch cassette, show characteristic curvature.
  2. MRI, myelograms, or CT scan with three dimensional reconstruction may be indicated for children with severe curvatures who have a known or suspected spinal column anomaly, before management decisions are made.
  3. Pulmonary function tests for compromised respiratory status.
  4. Evaluate for renal abnormalities in children with congenital scoliosis.

Nursing Interventions

  1. Prepare the child for casting or immobilization procedure by showing materials to be used and describing procedure in age-appropriate terms.
  2. Promote comfort with proper fit of brace or cast.
  3. Provide opportunity for the child to express fears and ask questions about deformity and brace wear.
  4. Assess skin integrity under and around the brace or cast frequently.
  5. Provide good skin care to prevent breakdown around any pressure areas.
  6. Instruct the patient to examine brace daily for signs of loosening or breakage.
  7. Instruct patient to wear cotton shirt under brace to avoid rubbing.
  8. Instruct about which previous activities can be continued in the brace.
  9. Provide a peer support person when possible so the child can associate positive outcomes and experiences from others.
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Daisy Jane Antipuesto RN MN

Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.

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