ADDOLESCENTS

with Health
Problems
NCM 102
PRECIOUS U. IMAM, RN
SCOLIOSIS
OVERVIEW
• LATERAL CURVATURE OF THE SPINE USUALLY
ASSOCIATED WITH A ROTARY DEFORMITY THAT
EVENTUALLY CAUSES COSMETIC AND PHYSIOLOGIC
ALTERATIONS IN THE SPINE, CHEST, AND PELVIS
• CAUSE IN 70% of CASES IS IDIOPATHIC, PROBABLY
TRANSMITTED AS AN AUTOSOMAL DDOMINANT
TRAIT WITH INCOMPLETE PENETRANCE
• MOST COMMON SPINAL DEFORMITY
• MORE FREQUENT IN ADOLESCENT : GIRLS DURING
GRWOTH SPURT
CLASSIFICATION
• NONSTRUCTURAL SCOLIOSIS : CURVE
IS FLEXIBLE AND CORRECTS BY
BENDING
• STRUCTURAL SCOLIOSIS: CURVE FAILS
TO STRAIGHTEN ON SIDE-BENDING:
CHARACTERIZED BY CHANGES IN THE
SPINE AND ITS SUPPORTING
STRUCTURES
CLINICAL FINDINGS
• PROMINENCE OF ONE HIP
• DEFORMITY OF THE RIB CAGE
• PROMINENCE OF ONE SCAPULA
• DIFFERENCE OF SHOULDER OR SCAPULAR HEIGHT
• CURVE IN THE VERTEBRAL SPINOUS PROCESS
ALIGNMENT
• BREASTS APPEAR UNEQUAL IN SIZE
• OTHER CLUES:
– CLOTHES DO NOT FIT RIGHT
– SKIRT HEMS ARE UNEVEN
THERAPEUTIC INTERVENTIONS
• SCREENING FOR SCOILIOSIS
• CONFIRMATION: X RAY
• DEPENDS ON THE SEVERITY OF THE CIRVATURE
– EXERCISE : SWIMMING
– MILD TO MODERATE CURVATURE
• Braces (Milwaukee)
• Low profile or underarm brace
– Treatment
• WORN 23 HOURS/DAY
• WEANED GRADUALLY: 1 TO 2 YEAR PERIOD
• WORN ONLY AT NIGHT UNTIL THE SPINE IS
MATURE
• ELECTRICAL STIMULATION
MILWAUKEE BRACE
MORE SEVERE CURVES
• SURGEYR TECHNIQUE
– ALIGNMENT
– INTERNAL OR EXTERNAL FIXATION
– HARRINGTON RODS
– LUQUE SEGMENTAL INSTRUMENTATION
– TEXAS SCOTTISH RITE HOSPITAL (TSRH)
SYSTEM
HARRINGTON RODS
LUQUE SEGMENTAL INSTRUMENTATION
MOST SEVERE CASES
• SPINAL FIXATION
• EXERCXISES BEFORE FUSION TO PROVIDE
MORE FLEXIBILITY AND PARTIAL
CORRECTION