Scoliosis (12) (Test 3) Week 9
Milwaukee brace
(full torso brace) -has a neck ring with rests for the chin and back of the head and wide bars in the front and back -used only when a TLSO is inadequate, such as for curvatures in the cervical spine
Risk Factors (seen mostly in who)
-Adolescents are at greatest risk (usually through a growth spurt) ages 9-15 -cerebral palsy or MD and having a family history of scoliosis. -curvature is girls is greater then boys
mild scoliosis treatment (3)
-Cobb angle 15-25 degrees -Observation every 3-6 months -Physical therapy
Moderate scoliosis treatment (3) (what do you begin to see)
-Cobb angle between 20 and 40 degrees; uneven hips or shoulders; differences in leg length; tiredness of the spine -Bracing for 12-23 hours per day with a TLSO or Milwaukee brace -pain meds
Severe scoliosis treatment (5)
-Cobb angle of greater than 40 degrees; prominent shoulder blade and/or rib bump; back and leg pain; difficulty breathing; nerve root compression -surgery (spinal fusion surgery) -Bracing after surgery with a TLSO brace -nonopioid or opioid meds -PT
Surgical correction of scoliosis is available for patients with
-Cobb angle of greater than 50 degrees. Surgery is usually performed only on patients whose curvature progression is not slowed by bracing and whose bones have stopped growing. If curve progression is severe (at least 45 degrees) before the child has stopped growing, surgeons may insert a rod that can be adjusted in length as the child grows; adjustments usually occur every 6 months -After spinal surgery, the patient will need to limit activities for 6-8 months
thoracolumbar sacral orthosis (TLSO) (aka & somtimes used with)
-also called the underarm brace or Boston brace -The TLSO is contoured to conform to the body and is almost invisible under the clothes. In severe cases, halo traction may be used to provide support for the spine.
vertical rotation no
-can be determined with the Nash-Moe method -In this method, a vertebra at the apex of the curve is divided into three equal segments on the half of the vertebra on the convex side of the curve -The location of the pedicle of the vertebra in relation to the segments determines the grade of rotation, with no rotation being the lowest and grade 4 rotation being the highest at over 90 degrees of rotation.
Severe scoliosis may cause (3)
-heart and lung problems such as difficulty breathing and pneumonia; compression of nerve roots may cause paralysis. -Curvature of more than 100 degrees may increase mortality rates.
X-rays can determine no
-most common imaging test used to definitively diagnose scoliosis. -Using an x-ray of the spine, physicians can determine the angle of the curve using the Cobb method -
Nonstructural scoliosis (2)
-occurs as the spine bends to compensate for poor posture, differences in leg length, presence of tumors, adaptation to pain -usually corrected by alleviating the underlying cause of the curve
Common manifestations of scoliosis include (6)
-spinal curvature to one side -uneven hips or shoulders -differences in leg length -tiredness of the spine -a prominent shoulder blade -a rib bump -uncommon: back pain
Scoliosis surgery involves
-spinal fusion combined with inserting metal rods on either side of the spine, which are held together by hooks, screws, and wires until the bone heals. -Surgery can correct the lateral curvature of the spine, but it often does not correct the abnormal rotation of the spine.
Nursing care/ Teaching after surgery
-teaching the patient how to move properly and confirming that the patient can independently perform ADLs (learn to perform simple tasks without bending or twisting the torso)
Congenital scoliosis occurs when (3)
-the individual is born with a curved spine. -This usually results from incomplete formation or separation of the vertebrae -can be associated with other health issues such as heart and kidney problems.
Scoliosis is diagnosed if (CURVES)
-the sideways curvature measures more than 10 degrees -Mild scoliosis: reflects a curve between 10 and 20 degrees -moderate scoliosis: is a curve between 20 and 40 degrees -severe scoliosis: curve over 40 degrees
The lateral curvature of the spine causes several structural changes to the skeleton (ribs)
-the vertebrae rotate, causing a twisting of the spine. The ribs on the inside of the curve are forced closer together, and the ribs on the outside of the curve are spread farther apart -this causes formation of the typical rib hump that is most obvious when the individual performs the Adam forward bend test.
Adam forward bend test
-which the individual leans forward at the waist with the arms hanging straight down -dam test often causes an obvious rib hump, usually on the right side
Structural scoliosis
a more severe form that involves deformities of the bones in the spinal column.
idiopathic scoliosis may be the result of
abnormal force exerted on the spine by surrounding connective tissues and muscles
teaching (3)
about the importance of attending regular follow-up appointments, and teaching proper body mechanics., wearing a brace,
scoliometer
can be used to measure the patient's rib hump when in the Adam position.
Scoliosis
is a lateral, or sideways, curve of the spine; it can be C-shaped or S-shaped
Neuromuscular scoliosis read
occurs when medical conditions that affect the nerves and muscles, such as cerebral palsy, Muscular dystrophy, or Spinal cord injury, lead to sideways curvature of the spine.
The most common curve pattern
right thoracic curve
When the patient is standing, determine whether (6)
the head is centered; whether the hips, shoulders, or rib cage appears uneven; whether one shoulder blade is more prominent; whether the legs are the same length; or whether the body leans to one side
TLSO
the most common type of brace worn both before and after surgery.
The Cobb method read
uses lines drawn from the end vertebrae (the vertebrae at the upper and lower limits of the curve that tilt most dramatically toward the apex of the curve) to estimate the degree of curvature. The angle found at the intersection of the two lines is the Cobb angle