Scoliosis & Spinal Screening

Kyphosis

Kyphosis or roundback, is an excessive curvature of the thoracic spine when viewed from the side.

What should be done FIRST if there are positive findings?

Re-screen before referring

Abnormal Spinal Curvature

Scoliosis is defined as an abnormal lateral curvature of the spine of 10 degrees or more. Scoliosis is further divided into two categories, Structural Functional

Structural Scoliosis

These curves are the result of changes in the alignment of the vertebrae. This twisting results in the hump on one side of the rib cage when the student bends forward.

Adams forward-bending test

standing erect with feet slightly apart and knees straight. With the palms of both hands touching, the student bends forward until the back is horizontal ***Examine the student in this position to check for: *Uneven contours, humps on one side *Any curve in the spine

A referral is considered complete when....

the physician's evaluation is recorded on the child's health record.

SURGERY

• Curvature > 45 degrees • Spinal fusion with internal instrumentation • Delayed as long as possible to allow maximum skeletal growth • Most common posterior fusion • Iliac bone graft can be used for the fusion

BRACING

• Neurovascular checks - 6 P's • Log rolling every 2 hours • Pulmonary toileting • Wound care • Pain - PCA pump • Rule out complications - neurological status lower extremities, fluid status, bleeding, return of bowl function

MANAGEMENT

• Regular and periodic observation with radiographic evaluation • Spinal fusion surgery • Body image - talk about diagnosis, treatment, and feeling about experience • Discuss activities - school or activities • Notify school nurse

DIAGNOSTIC EVALUATION

• Routine scoliosis screening • Radiographic examination

SCOLIOSIS

• Three dimensional deformity involving rotation of the vertebral bodies. • Causes the rib cage to become misshapen • Body develops a compensatory curve to maintain posture and balance • Nonstructural scoliosis does not involve rotational or muscular deformity due to poor posture.

CLINICAL MANIFESTATIONS

• Visible curve of the spine • A rib hump when bending forward • Asymmetric rib cage • Uneven shoulder or pelvic heights • Prominence of scapula or hip • Difference in space between arms and trunk when standing • Apparent leg-length discrepancy

BRACING

• Worn 18-23 hours a day • Wear 100% cotton, seamless T-shirt • Proper skin care • Clean inside/outside of brace daily • Notify HCP - numbness tingling of arms, leg, fee, cracks or breaks in brace, skin problems, respiratory problems

DISCHARGE TEACHING

• Wound care • Importance of well balance diet • Activity restrictions (Orthoplast jacket) • Report to HXCP - skin breakdown, wound infection, numbness/tingling extremities, difficulty breathing • Provide information about National Scoliosis Associations

Screening Steps 1-6

(1) With the student facing front in the standing position (Figure 6), the examiner checks for the following signs of a possible abnormal spinal curvature. (2) The next position is the Adams forward-bending test. Examine the student in this position to check for: Uneven contours, humps on one side and any curve in the spine (3) View the student from the side in the standing position and check for: Exaggerated roundness in upper back and exaggerated arch in lower back (4) Next, view the student from the side in a forward-bend position checking for: Uneven contours, humps on one side and flexibility - can the student bend forward and touch upper shins or feet (5) View the student from the back in the standing position and note any of the following: Head is not centered directly above crease in buttocks, one shoulder blade wing is higher or stands out more than the other, uneven waist creases, uneven hip levels, one shoulder higher than the other, larger space from arm to the side of the body (comparing both sides), curved spine (6) Finally, view the student from the back in the forward-bending position to check for: uneven contours, humps on one side, any curve in the spine

signs of a possible abnormal spinal curvature:

*One shoulder higher than the other *Larger space from arm to the side of the body (compare both sides) *Uneven waist creases *Uneven hip levels

What should you do if for some physical condition a student cannot stand in the manner necessary for the Adam's forward-bend test?

*do NOT attempt to screen that student *Ask the parents or legal guardian to request a medically appropriate spinal screening from the student's primary physician. *Request the results of this screening for the school's records and the DSHS Spinal Screening Report. *On the Spinal Screening Report, indicate this student as a referral. Once the parents return the results of a physician's exam, enter the data into the diagnosis/treatment section as appropriate.

idiopathic scoliosis

*no known cause *85% of all cases of structural scoliosis *occurs in 2 to 3 % of the adolescent population ( ages 10 to 14 for girls and 12 to 16 for boys. * Family history of scoliosis can also be a contributing factor. *****Carrying a heavy load such as books on one side cannot cause idiopathic scoliosis******

DEGREES

10 to 20 a slight curve • More than 40% curve requires surgery • More than 80% compromises respiratory function and is considered severe

Functional Scoliosis

In this type there are no permanent changes in the shape or structure of the spine. It develops secondary to another abnormality usually in the hip or lower extremity.

Management options for spinal deformities consist of the three "O"s

Observation Orthosis (Brace) Operation

When is Spinal Fusion and Instrumentation performed in children?

Usually surgery is reserved for teens and pre-teens that already have a curve of 45 degrees or more

the normal spine

When viewing the back directly from behind, the spine is straight, the shoulders even, hips are level and the distance between the arms and the body are equal.

Frequency of Screening in Texas by law

all children in grades 6 and 9 attending public and private schools shall be screened for abnormal spinal curvature before the end of the school year. Schools may implement a program that includes screening in grades 5 and 8 as an alternative to grades 6 and 9.

The spine is divided into four main areas:

cervical, thoracic, lumbar and sacral