- 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
- 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.
- 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.
- Paralytic or musculoskeletal scoliosis – develops several months after symmetrical paralysis of the trunk muscles from polio, cerebral palsy, or muscular dystrophy.
- Neuromascular scoliosis – child has a definite neuromascular condition that directly contributes to the deformity.
- Additional but less common causes of scoliosis are osteopathic conditions, such as fractures, bone disease, arthritic conditions, and infections.
- Miscellaneous factors that can cause scoliosis include spinal irradiation, endocrine disoders, postthoracotomy, and nerve root irritation.
- As the deformity progresses, changes in the thoracic cage increase. Respiratory and cardiovascular compromise can occur in cases of severe progression.
- Poor posture, uneven shoulder height.
- One hip more prominent than the other.
- Scapular prominence.
- Uneven waist line or hemline
- Spinal curve observable or palpable on both upright and bent forward.
- Back pain may be present but is not a routine finding in idiopathic scoliosis.
- Leg length discrepancy.
- 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.
- X-ray of the spine in the upright position, preferably on one long 36-inch cassette, show characteristic curvature.
- 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.
- Pulmonary function tests for compromised respiratory status.
- Evaluate for renal abnormalities in children with congenital scoliosis.
- Prepare the child for casting or immobilization procedure by showing materials to be used and describing procedure in age-appropriate terms.
- Promote comfort with proper fit of brace or cast.
- Provide opportunity for the child to express fears and ask questions about deformity and brace wear.
- Assess skin integrity under and around the brace or cast frequently.
- Provide good skin care to prevent breakdown around any pressure areas.
- Instruct the patient to examine brace daily for signs of loosening or breakage.
- Instruct patient to wear cotton shirt under brace to avoid rubbing.
- Instruct about which previous activities can be continued in the brace.
- Provide a peer support person when possible so the child can associate positive outcomes and experiences from others.