SCOLIOSIS, KYPHOSIS AND LORDOSIS

Clinical Overview

 Scoliosis – is a sideways curvature of the spine that most often is diagnosed in

adolescents. While scoliosis can occur in people with conditions such as cerebral palsy
and muscular dystrophy, the cause of most childhood scoliosis is unknown
 Kyphosis - is a forward curvature of the spine in the upper back — best seen from the
side, in contrast to scoliosis — giving a child an abnormally rounded or “humpback”
appearance. It is a type of inflexible spinal deformity and should not be confused with
poor posture or "round back," which is flexible.
 Lordosis - is a deformity of the backbone (spine). It’s when the bones of the spine
(vertebrae) in the lower back curve inward more than normal. A child with lordosis has a
swayback appearance.
Signs and Symptoms

 Scoliosis
- Uneven shoulder blades with one being higher than the other
- An uneven waist or hip
- Leaning toward one side
- Obvious curvature of the spine
- Back pain
 Kyphosis
- Bending forward of the head compared to the rest of the body
- Hump or curve to the upper back
- Fatigue in back or legs (Tight hamstring)
- Rounded back
 Lordosis
- Appearing swayback, with the buttocks being more pronounced
- Having a large gap between the lower back and the floor when lying on your back on
a hard surface that does not change when you bend forward
- Back pain and discomfort
- Problems moving certain ways
Goals of Collaborative
- Restoration of normal breathing pattern
- Relief of pain
- Improved physical mobility
- Enhanced learning
- Stop the progression of the curve
 - Prevent deformity
Nursing Diagnosis
- Ineffective Breathing Pattern related to musculoskeletal impairment, decreased lung
expansion and hypoventilation syndrome
- Impaired Physical Mobility related to Musculoskeletal impairment, pain and
discomfort
- Disturbed Body Image related to Biophysical and psychosocial factors of spinal
deformity
- Knowledge Deficiency related to lack of information about correction of functional
or structural scoliosis
Risk Factors

 Scoliosis
- Age. Signs and symptoms typically begin in adolescence.
- Sex. Although both boys and girls develop mild scoliosis at about the same rate, girls
have a much higher risk of the curve worsening and requiring treatment.
- Family history. Scoliosis can run in families, but most children with scoliosis don't
have a family history of the disease.
- Bone tumors, Neuromuscular disorders (e.g. Duchenne muscular dystrophy)
 Kyphosis
- Poor Posture, weak back muscles, older age, vertebral fracture, osteoporosis,
degenerative disc disease, arthritis
- Genetic disease affecting bone, ligaments: Osteogenesis imperfecta, Marfan
syndrome, Ehler-Danlos syndrome, Glycogen storage disease.
 Lordosis
- Poor posture, muscle strength imbalance
- Musculoskeletal: Osteoporosis, spondylolisthesis
- Genetic – Achondroplasia, Ehler-Danlos Syndrome
Diagnosis

 Scoliosis
Physical Examination:
Cobb method – a process of measuring the curvature of the spine. A positive diagnosis od
scoliosis can be made with a curvature greater than 10 degrees. A curvature of the spine
between 25-30 degrees is considered significant while curves greater than 45-50 degrees
are severe and may require more intensive treatment.
Adam’s Forward Bend – this standard screening tool is often used by pediatricians in grade
school screenings. The test involves the person leaning forward at 90 degrees at the waits
 while keeping the feet together. The examiner can then easily assess for asymmetry of the
spine.
Imaging studies:
Xray – a simple x-ray imaging can identify spinal curvature
CT Scan or CAT scan – a CT scan image can show the size and shape of the spinal canal. This
imaging technique gives more information about the spine and surrounding organs as
compared to X-ray imaging.
MRI Imaging – an MRI scan can produce three-dimensional images of the spinal structures.

 Kyphosis
A diagnosis of kyphosis is made by detecting a severe curvature of the upper portion of your
child's spine on an X-ray. If possible, we try to use adequate imaging without excessive
radiation exposure.
Other diagnostic tests may include:
- Magnetic resonance imaging (MRI), which uses a combination of large magnets,
radiofrequencies and a computer to produce detailed images of organs and
structures within the body. An MRI does not expose your child to radiation.
- Computed tomography (CT) scan, which uses a combination of X-rays and computer
technology to produce cross-sectional images ("slices") of the body.
- EOS imaging, an imaging technology that creates 3-dimensional models from two
planar images. Unlike a CT scan, EOS images are taken while the child is in an upright
or standing position, enabling improved diagnosis due to weight-bearing positioning.
- Pulmonary function tests to determine lung capacity.

 Lordosis
The doctor makes the diagnosis of lordosis with a complete medical history of the child,
physical examination, and diagnostic tests. Your child's doctor obtains a complete prenatal and
birth history of the child and asks if other family members are known to have lordosis.
Diagnostic procedures may include:
- X-rays. This diagnostic test uses invisible electromagnetic energy beams to produce
images of internal tissues, bones, and organs onto film. This test is used to measure
and evaluate the curve. With the use of a full-spine X-ray, the doctor or radiologist
measures the angle of the spinal curve. A determination for treatment can often be
made based on this measurement.
- Bone scans. Bone scans are a nuclear imaging method to evaluate any degenerative
and/or arthritic changes in the joints; to detect bone diseases and tumors; to
 determine the cause of bone pain or inflammation. This test is to rule out any
infection or fractures.
- Magnetic resonance imaging (MRI). This diagnostic procedure uses a combination of
large magnets and a computer to produce detailed images of organs and structures
within the body. This test is done to rule out any associated abnormalities of the
spinal cord and nerves.
- Computed tomography (CT) scan. This diagnostic imaging procedure uses a
combination of X-rays and computer technology to produce horizontal, or axial,
images (often called slices) of the body. A CT scan shows detailed images of any part
of the body, including the bones, muscles, fat, and organs. CT scans are more
detailed than general X-rays.
Treatment

 Scoliosis
Treatment for scoliosis may include:
- Observation. If there is a slight curve your doctor may choose to check your back
every four to six months to see if the curve gets worse.
- Bracing. Depending on the degree of the curve, a back brace is sometimes
prescribed for kids and adolescents who are still growing. Bracing can help prevent
the curve from getting worse.
- Surgery. If the curve is severe and is getting worse, surgery is sometimes needed.
- Body casting. A cast is placed from the shoulders to the lower trunk while the child is
under anesthesia. It is replaced every few months for up to 3 years. This is usually
reserved for young children when a scoliosis curve looks like it will get worse as they
grow.
Exercise programs, chiropractic treatment, electrical stimulation, and nutritional
supplements have not been proven to prevent the worsening of scoliosis. It is still ideal
to keep as much as strength and flexibility to maintain normal function. This may
require more effort and attention in someone with scoliosis.

 Kyphosis
Treatment for kyphosis may include:
- Exercise and anti-inflammatory medication to ease pain or discomfort
- Wearing a back brace
- Surgery to correct severe spine curvature and congenital kyphosis
- Exercises and physical therapy to increase muscle strength

 Lordosis
 Treatment for lordosis may include:
- Medication to relieve pain and swelling
- Exercise and physical therapy to increase muscle strength and flexibility
- Wearing a back brace
- Weight loss
- Surgery
Complications

 Scoliosis
- Breathing problems. In severe scoliosis, the rib cage may press against the lungs,
making it more difficult to breathe.
- Back problems. People who had scoliosis as children may be more likely to have
chronic back pain as adults, especially if their abnormal curves are large and
untreated.
- Appearance. As scoliosis worsens, it can cause more noticeable changes — including
uneven hips and shoulders, prominent ribs, and a shift of the waist and trunk to the
side. Individuals with scoliosis often become self-conscious about their appearance.
 Kyphosis
- Breathing problems. Severe kyphosis can put pressure on the lungs.
- Limited physical functions. Kyphosis is associated with weakened back muscles and
difficulty doing tasks such as walking and getting out of chairs. The spinal curvature
can also make it difficult to gaze upward or drive and can cause pain when you lie
down.
- Digestive problems. Severe kyphosis can compress the digestive tract, causing
problems such as acid reflux and difficulty with swallowing.
- Body image problems. People with kyphosis, especially adolescents, may develop a
poor body image from having a rounded back or from wearing a brace to correct the
condition. For older people, poor body image can lead to social isolation.
 Lordosis
- These include spine disorders, muscular dystrophy, developmental problems of the
hip, or nervous system disorders.