Scoliosis

SCOLIOSIS SCOLIOSIS •

Lateral curvature of the spine involving rotation of the vertebral bodies

TYPES • •

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Idiopathic Scoliosis o No apparent cause – The most common – Genetic disposition (adolescent girls) Congenital Scoliosis o Born with a Vertebral abnormality o Prognosis variable, depends on client repair because resp. o Depends on what the defect is Paralytic Scoliosis o Neuromuscular TX – Very complex; a palliative thing to help deal with the neuromuscular disease along with trying to work with the NM disease  A child with MD will loose muscle tone throughout their life; they can’t even hold themselves up; the Harrington rod will be placed to keep back straight and allows the lings to expand as much as possible. o As a result of some other type disease o Seen with neurogenic disease such as CP, MD – tx compiles o Spine rotates due to loss of muscle control

INCIDENCE •

Most common spinal deformity

CLINICAL MANIFESTATIONS • • • • • • • • • • •

Visible curve of the spine (X-Ray) Rib hump when the child is bending forward and the ribs are not at an even level Asymmetric rib cage Uneven shoulder and or pelvic heights Difference in the space between the arms and the trunk when standing Apparent leg-length discrepancy (Pant/Shirt not hanging evenly) In severe cases, usually paralytic types o They have reduced vital capacity – Complication Disproportionately short thorax and long arms Assessment at pt. Growth spurt (rare in males) usually around age 9 but 10adolensence(15) Not usually noted by family members; the parents get adjusted to the unevenness Usually a teacher notices a skirt does not hang evenly

DIAGNOSTIC EVALUATION • • •

Observation They are then sent to get an X-ray or radiographic exam to diagnose o MRI – Determines not a tumor or mass Usually screening done around 9-15 years of age

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Confirm and assist with treatment Treatment will be based on degree of curvature

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Long term aimed at maintaining spinal stability. Prevent further progression of deformity until bone growth is completed.

THERAPEUTIC MANAGEMENT

TREATMENT o 0-20o  

No treatment recommended They will monitor and follow up and make sure it does not become worse

o 20-40o        

A non surgical intervention Exercise or walking may be an intervention to decrease curvature Following with X rays and using some sort of Brace device The Brace depends on situation Milwaukee Brace – wear 23 out of 24 hours A lot of problems with compliance Body Image disturbance Brace is not fitted until the child has stopped growing then they will start treating it. It is very expensive

o >40o    

o >80o 

Surgery; Major Surgery Very long and involves every body system Will look at this very carefully before having done Will be done when their lung capacity if being affected • Will do a fusion of the vertebra; It will not grow • The child will not grow any more in height after the fusion • Usually wait as long as possible before the surgery Life threatening (Lung and Respiration)

BRACING o

Depends on MD; Wear brace months; May Ambulate with brace

SURGICAL PROCEDURES o Herrington rods  



Straighten curve with rods / hooks (1 yr fusion takes place) Uses bone graft to attach rods or hooks to vertebra • Logroll • Flat bed – 7-10 days • Body Brace / Cast Usually 6 months Usually done in the summer so not to miss school

o Spinal fusion 

Will wait as long as possible because this will stop growth.

o Cotrel Dubousset 

(France) Metal rods applied differently with hooking vertebral with increased movement. No brace post op, up to 2-5 days logroll.

PROGNOSIS •

Excellent Can be prepared to deal with and the person can do fine after the surgery

• • •

Will be monitored closely with follow up The older the child at the time it appears the better the prognosis The younger the more severe

NURSING CARE • • • • • • • • • • •

A lot of teaching Must wear the brace; because if they don’t wear the brace they may have to have surgery If they do have the surgery: o Showing them the equipment; talk about logrolling; talk to a person that has been through this Let them know post op they will have a lot of pain; usually on a PCA pump Fluid status: they have lost a lot of fluid; usually a lot of bleeding during the surgery Positioning: they have to logroll; cannot get up; catheter or bedpan. Respiratory Function: May be painful to breathe As patient stabilizes: Mobility increases quickly and diet progresses with GI function returns. Discharged usually on 5th day o If Harrington rod they may stay longer Long term follow up and close monitoring Compliance is very important – The surgery may or may not work depending if the parents bring them in for follow up.

NURSING DIAGNOSIS • • • • • • • •

Risk for impaired skin integrity related to wearing of a brace; surgery Knowledge deficit related to lack of information about the natural history of scoliosis and available treatment modalities Days after surgery: Body image disturbance related to a postural deformity, to bracing, or to a surgical scar on back Anxiety related to impending surgery; brace Risk for injury related to neurovascular deficit secondary to instrumentation (complaint with post op treatment) Pain related to the operative procedure Immediate Post OP : Ineffective airway clearance related to long-term anesthesia and intubation, immobility, and pain associated with spinal fusion; curvature of spine Knowledge deficit related to home care following spinal fusion (Increase R/F noncompliance)

PREOPERATIVE • • • • • • • •

Life threatening surgery that will affect every body system Tubes (not Foley, IV) Teach about long term recovery Risk for Increase blood loss Possible brace ICU Care Log Roll Painful

DISCHARGE

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Usually 5th postop day As stabilize their mobility will increase within a couple of days GI Function, then increase diet