STRUCTURAL DEFORMITIES

SCOLIOSIS, KYPHOSIS, LORDOSIS

 WHAT IS SCOLIOSIS?

• SCOLIOSIS IS A LATERAL (SIDEWAYS) CURVATURE OF THE SPINE. IT MAY INVOLVE ALL OR ONLY
A PORTION OF THE SPINAL COLUMN.
• IT MAY BE FUNCTIONAL (A CURVE CAUSED BY A SECONDARY PROBLEM) OR STRUCTURAL (A
PRIMARY DEFORMITY).
 2 TYPES OF SCOLIOSIS

• FUNCTIONAL/ POSTURAL SCOLIOSIS

- OCCURS AS A COMPENSATORY MECHANISM FOR THOSE WHO HAVE UNEQUAL LENGTHS,
• STRUCTURAL SCOLIOSIS
- IDIOPATHIC, PERMANENT IN CURVATURE OF THE SPINE ACCOMPANIEDBY DAMAGE TO THE
VERTEBRAE.
 RISK FACTORS

• AGE- SIGNS AND SYMPTOMS TYPICALLY BEGINS DURING THE GROWTH SPURT THAT OCCURS
JUST PRIOR TO PUBERTY
• SEX- GIRLS HAVE HIGHER RISK OF THE CURVE WORSENING AND REQUIRING TREATMENT
• FAMILY HISTORY
 POSSIBLE COMPLICATIONS

• LUNG AND HEART DAMAGE

• BACK PROBLEMS
• APPEARANCE
 PATHOPHYSIOLOGY

• BIRTH DEFECT, DEFECT IN FORMATION OF BONES

• ASYMMETRIC DISC DEGENERATION THERE IS PROGRESSIVE DEFORMITY WITH POTENTIAL FORAMINAL OR
CENTRAL CANAL STENOSIS DUE TO OSTEOPHYTES AND LIGAMENTUM BUCKLING
• CEREBRAL PALSY
• PARALYSIS
• DUSCHENNE MUSCULAR DYSTROPHY, THE DEMONSTRATE DIFFICULTY WITH POSITIONING AND COMFORT IN
THEIR WHEELCHAIRS DUE TO CHANGE IN POSTURE AND DEVELOPMENT OF PELVIC OBLINQUITY
• OSTEOPOROSIS
• SPINAL FRACTURES
• DURING PERIODS OF RAPID GROWTH THE SPINAL CORD BECOMES WORST, IF THE CURVES
BECOME SEVERED IT CAN CAUSE PROBLEMS IN POSTURE, WALKING AND BACK PAIN. IT CAN
ALSO CAUSE THE INTERNAL ORGANS TO BECOME CRAMPED FOR SPACE THAT CAN CAUSE
HEART, BREATHING, AND DIGESTION PROBLEMS
 DIAGNOSTIC TEST

• RADIOGRAPHS AND PHOTOGRAPHS

• PHYSICAL EXAMINATION
• PULMONARY FUNCTION STUDIES
• SCOLIOMETER TO MEASURE CURVATURE FOR SCOLIOSIS
• NEUROLOGICAL EXAM TO TEST OR MUSCLE WEAKNESS, NUMBNESS, AND ABNORMAL
REFLEXES
 SYMPTOMS OF SCOLIOSIS

• S-SHAPED OR C-SHAPED SPINAL CORD

• BACK PAIN
• IF THE PATIENT BENDS FORWARD THE CURVES BECOMES MORE NOTICEABLE
• UNEVEN SHOULDERS
• ONE SHOULDER BLADE APPEARS MORE PROMINENT THAN THE OTHER
• UNEVEN WAIST
• ONE HIP HIGHER THAN THE OTHER
 TREATMENT

• NO THERAPY IF THE CURVATURE IS LESS THAN 20 DEGREES

• NON-SURGICAL APPROACH MAY INCLUDE BODY BRACE OR TRACTION
• IF THE CURVES ARE GREATER THAN 40 DEGREES, IT REQUIRES SURGERY WITH SPINAL FUSION
• IF NECK AND PELVIC TRACTION WERE APPLIED BEFOREHAND, THIS ACHING IS MINIMIZED
• HALO TRACTION USE OF OPPOSING FORCES TO STRAIGHTEN AND REDUCE SPINAL CURVES.
• SURGICAL INTERVENTION: SPINAL INSTRUMENTATION USE OF RODS, SCREWS, AND WIRES
PLACED IN A SPINAL COLUMN TO PROVIDE FIRM REDUCTION.
• COTREL-DUBOUSSET RODS ARE USED
• POSTERIOR SPINAL FUSION WITH INSTRUMENTATION AND BONE GRAFTING
• ACETAMINOPHEN FOR MILD PAIN
• BRACES SHOULD BE WORN OVER A T-SHIRT
 KYPHOSIS

• ROUNDING DEFORMITY OF THE UPPER NECK

• ALSO KNOWN AS ROUNDBACK, OR KELSO’S HUNCHBACK
 KINDS OF KYPHOSIS

• POSTURAL KYPHOSIS, USUALLY ATTRIBUTED TO SLOUCHING CAN OCCUR IN BOTH OLD AND
YOUNG.
• SCHEUERMANN’S KYPHOSIS, CONSIDERED A FORM OF JUVENILE OSTEOCHONDROSIS
• CONGENITAL KYPHOSIS, CAN RESULT IN INFANTS WHOSE SPINAL COLUMN HAS NOT DEVEOPED
CORRECTLY IN THE WOMB
• NUTRITIONAL KYPHOSIS, CAN RESULT FROM VITAMIN D DEFICIENCY THAT MAY CAUSE RICKETS THAT
SOFTENS THE BONES AND RESULTING IN CURVING OF SPINE AND LIMBS OF THE CHILD
• POST-TRAUMATIC KYPHOSIS, MAY ARISE FROM UNTREATED OR INEFFFECTIVELY VERTEBRAL
STRUCTURE.
 RISK FACTORS

• OSTEOPOROSIS
• GENDER, WOMEN COMMONLY POSTMENOPAUSAL
• GENETIC
 PATHOPHYSIOLOGY OF KYPHOSIS

BRITTLING/ ABNORMAL FORMATION OF THE BONES CAUSES PATHOLOGICAL CURVATURE OF

THE THORACIC CAVITY THAT CAN LEAD COMPRESSION OF THE INNER ORGANS LIKE LUNGS,
HEART, BACK PAIN AND NERVES
 SYMPTOMS OF KYPHOSIS

• MILD TO SEVERE BACK PAIN

• BACK PAIN WITH MOVEMENT
• FATIGUE
• TENDERNESS AND STIFFNESS IN THE SPINE
• FORWARD POSTURE OF THE HEAD
• CHEST PAIN OR DIFFICULTY IN BREATHING
• DIFFERENCE IN SHOULDER HEIGHT
• TIGHT HAMSTRINGS
 DIAGNOSTICS

• RADIOGRAPHS AND PHOTOGRAPHS

• PULMONARY FUNCTION TEST
 TREATMENT

• MONITORING OF THE CURVE FOR OVER MANY YEARS

• EXERCISES TO STRENGTHEN MUSCLES AND IMPROVE POSTURE
• PHYSICAL THERAPY
• PAIN MEDICATIONS
• WEARING BACK BRACE
 SURGICAL INTERVENTIONS

• KYPHOPLASTY TO ARREST THE DEFORMITY AND RELIEVE THE PAIN.

 LORDOSIS

• EXCESSIVE INWARD CURVE OF THE SPINE.

• COMMONLY KNOWN AS SWAY BACK OR BAASTRUP DISEASE
 CAUSES

• SPINES, DEPENDS ON HOW THE SPINE IS FORMED

• LEGS, ODD BODY FORMATION IS WHEN AN INDIVIDUAL HAS LEG SHORTER THAN THE OTHER
• GROWTH SPURT
• IMPROPER LIFTS
• OVERUSE
 PATHOPHYSIOLOGY OF LORDOSIS

• ACHONDROPLASIA, ABNORMAL GROWTH OF BONES

• SPONDYLOLISTHESIS, COMMON IN LOWER BACK, VERTEBRAE SLIPS FORWARD
• OSTEOPOROSIS, IT COMPROMISES THE STRUCTURAL INTEGRITY OF THE SPINE
• OBESITY, USUALLY OBESE PEOPLE TEND TO LEAN BACKWARD TO IMPROVE BALANCE
• DISCITIS, OR INFLAMMATION OF THE DISC SPACE BETWEEN BONES OF THE SPINE MOST OFTEN CAUSED BY AN
INFECTION
• BENIGN JUVENILE LORDOSIS CAN PROGRESS IF NOT TREATED
• EXCESSIVE CURVATURE OF THE BACK CAUSING PAIN AND DISCOMFORT THAT CAN AFFECT THE ABILITY TO
MOVE IF LEFT UNTREATED.
 SIGNS AND SYMPTOMS

• SWAYBACK WITH BUTTOCKS BEING PRONOUNCED

• HAVING LARGE GAP BETWEEN THE LOWER BACK AND THE FLOOR WHEN LYING DOWN
• BACK PAIN AND DISCOMFORT
• BACK PAIN
• PROBLEMS IN MOVING
 DIAGNOSTIC TEST

• PHYSICAL EXAM
• NEUROLOGICAL EXAMINATION IF PATIENT IS EXPERIENCING TINGLING OR NUMBNESS,
MUSCLE SPASMS OR WEAKNESS
• CHANGES IN BLADDER AND BOWEL CONTROL
• RADIOGRAPHS AND PHOTOGRAPHS
 TREATMENT

• EXERCISES MAY BE PRESCRIBED TO ALLEVIATE DISCOMFORT ASSOCIATED WITH OVERSTRETCHED BACK

MUSCLES
• GENTLE TRACTION TO MINIMIZE PAIN
• BODY BRACES
• PHYSICAL THERAPY
• ELECTRICAL STIMULATION
• PHYSICAL THERAPY
• WEIGHT LOSS
• SURGERY
 SURGICAL INTERVENTION

• IN SITU FUSION, FROM T5 TO S1, USING PEDICLE SCREWS WITH BONE GRAFT OBTAINED
FROM THE ILIAC CREST
 NURSING RESPONSIBILITIES

• EMOTIONAL SUPPORT, ENCOURAGE PATIENT TO REMAIN SOCIALLY ACTIVE AS POSSIBLE

• AVOID CONTACT SPORTS
• AVOID LIFTING OR CARRYING HEAVY THINGS
• ENCOURAGE ANNUAL CHECK-UPS
• ENCOURAGE EXERCISE OR ACTIVE ROM AS TOLERATED
• ENCOURAGE RESTING PERIODS
 NURSING DIAGNOSIS

• SITUATIONAL LOW SELF-ESTEEM RELATED TO OBVIOUSNESS OF THE BRACES USED FOR

SCOLIOSIS/KYPHOSIS/LORDOSIS CORRECTION
• RISK FOR INJURY
• IMPAIRED PHYSICAL MOBILITY
• RISK FOR IMPAIRED SKIN INTEGRITY
• RISK FOR DISTURBED BODY IMAGE
• RISK FOR NONCOMPLIANCE