SCOLIOSIS

INTRODUCTION

Scoliosis came from the greek word “skolios” meaning crooked. It is marked by
an abnormal sideways curvature in the spine and occurs most often during the
growth spurt just before puberty.
According to the American Association of Neurological Surgeons (AANS), about
80% of scoliosis cases have no identifiable cause.  About 3% of adolescents have
scoliosis. The severity of scoliosis can range from mild to severe and is determined
by a specialized measurement known as the Cobb angle. Most cases of scoliosis are
mild, but some spine deformities continue to get more severe as children grow.
Severe scoliosis can be disabling. An especially severe spinal curve can reduce the
amount of space within the chest, making it difficult for the lungs to function
properly. Severe cases of scoliosis can lead to other spinal conditions such as
herniated discs and spinal stenosis. There are four main types of scoliosis based on
different causes, risk factors, and age groups: congenital, idiopathic, neuromuscular,
and degenerative. Females and adolescents are more prone to scoliosis.
LEARNING OBJECTIVES
At the end of this lecture, the students should be able
to:
- Understand the definition of Scoliosis
- Understand the pathophysiology of the disease
- Determine what are the clinical features of the disease
- Determine what are the diagnostic and laboratory
procedure done in patient with Scoliosis
- Learn the managements in taking care of patient with
Scoliosis
TOPIC CONTENTS
1. Definition
2. Etiology
3. Risk Factors
4. Clinical Manifestations and
Pathophysiology
5. Diagnostic Procedures
6. Medical Management
7. Surgical Management
8. Nursing Diagnosis and Management
9. Complications
10. References
DEFINITION

“Scoliosis”
Scoliosis is an abnormal sideways curvature of the spine.
Curvature can occur to the right (dextroscoliosis) or to the left
(levoscoliosis) and occurs as an ‘S’ (2 curve present) or ‘C’ shaped
curvature (1 curve present).
Scoliosis can affect any of the four spinal regions: cervical (neck),
thoracic (mid back), lumbar (lower back), and sacrum. It may
affect more than one area at a time though it most commonly
affects the lumbar and thoracic regions (Thoraco-lumbar spine).
DEFINITION
The angle of the curve that measures more than 10 degrees
on an X-ray is considered scoliosis.
The condition is often diagnosed during the first 7 years of a
child’s life or it occurs most often during the growth spurt
(10-15 years old) just before puberty.
General Categories
Structural scoliosis is by far the
most common category of
scoliosis. It involves spinal rotation
in addition to the side-to-side
curvature of the spine. This type
of scoliosis affects the spine’s
structure and is considered
permanent unless the spine
receives treatment.
Nonstructural scoliosis, also
known as functional scoliosis,
results from a temporary cause
and only involves a side-to-side
curvature of the spine (no spinal
rotation). The spine’s structure is
still normal.
Types
1. Idiopathic scoliosis is scoliosis
without a known cause. It accounts for
about 8 in 10 cases of scoliosis. This
type of scoliosis typically presents
during adolescence, but it can also start
earlier in childhood or infancy.
Idiopathic scoliosis is broken down by
age group:
Infant: 0 to 3 years
Juvenile: 4 to 10 years
Adolescent: 11 to 18 years
Adult: 18+ years
2.Degenerative scoliosis is adult
scoliosis is a common condition
that occurs later in life as the joints
in the spine degenerate. It usually
develops in the lower back as the
disks and joints of the spine begin
to wear out as you age.
3. Neuromuscular scoliosis may
also be called myopathic scoliosis.
It sometimes develops in
individuals with neuromuscular
condition such as spina
bifida, cerebral palsy, spinal cord
injury, or a muscular dystrophy.
Types
4. Congenital scoliosis develops in
utero and is present in infancy. It
begins as a baby’s back develops
before birth. A rare condition,
affecting 1 in 10,000, it can result
from malformations in the
vertebrae or other causes.
In most cases, the spinal curve
must be corrected surgically.
Congenital scoliosis branches further
into two major types:
Hemivertebrae are vertebrae that
are not completely formed and are
the most common type of congenital
malformation.
Unilateral bar, also called block
vertebrae, is a failure of the vertebral
bodies to separate into single,
distinct vertebra during formation
which results in a spinal fusion.
Types
5. Miscellaneous Scoliosis is caused by a few rare conditions, like Ehlers-
Danlos or Marfan syndrome.
Classification
Mild scoliosis generally is used to refer to
cases where the Cobb angle is 20 degrees
or less and exercises are traditionally
recommended. 
Moderate scoliosis ranges between 20
and 40 degrees, and it is at this stage
that bracing is typically recommended for
an adolescent. 
Severe scoliosis is often used to refer to
cases that are typically around 40 degrees
in an adolescent or 45 degrees in an
adult, and have reached the level where
an orthopedic surgeon would
recommend surgery.
ETIOLOGY
Common Causes:
1. Cerebral palsy, spina bifida, and 5. Infections
muscular dystrophy
6. Tumors
2. Idiopathic or unknown
3. Birth defects 7. Genetic conditions like Marfan
syndrome and Down syndrome
4. Degenerative changes such as
arthritis, osteophyte (bone spurs) 8. Muscle spasms
formation, disc dehydration (drying out
of the intervertebral disc), failure of
9. Difference in leg heights
facet joints to form properly in the spinal 10. Inflammation
column, and osteopenia or osteoporosis
RISK FACTORS
Non Modifiable Modifiable
1. Age 1. Weight
2. Sex 2. Decreased Estrogen
3. Family History 3. Smoking
4. High impact movement and
repetitive motions from sporting
activities
CLINICAL MANIFESTATIONS
- One shoulder blade that’s higher than the other
- One shoulder blade that sticks out more than the other
- Uneven hips
- A rotating spine
- Problems breathing because of reduced area in the chest for lungs to
expand
- Back pain
DIAGNOSTIC PROCEDURES
1. Adam’s Forward Bend Test is a
very sensitive test for scoliosis and
it is therefore the most frequent
screening test for scoliosis.
DIAGNOSTIC PROCEDURES

2. Scoliometer Test is used in

conjunction with a forward bend
test, also known as an Adam’s
test.
DIAGNOSTIC PROCEDURES

3. X-ray
This can uncover underlying
causes including partially formed
vertebral bodies, fused vertebral
bodies, or lack of skeletal maturity
and it can determine the degree
or progression of spinal curvature.
DIAGNOSTIC PROCEDURES

4. Cobb Angle Measurement is

often referred to as the ‘gold
standard’ for assessing scoliosis.
The Cobb angle is measured via X-
ray and is determined by the most
tilted vertebrae in each curve.
DIAGNOSTIC PROCEDURES

5. CT Scan (Computed
Tomography Scan) are mainly
used to assess the bony anatomy
of the spine; it would be used to
look for any partially formed
vertebral bodies, or fused
vertebrae.
DIAGNOSTIC PROCEDURES

6. MRI (Magnetic Resonance

Imaging) scans are primarily used
to look at the soft tissue of the
body, such as intervertebral discs
and nerves. 
MEDICAL MANAGEMENT
1. Bracing
Considered in patients if there has been a five degree Cobb angle increase in
the scoliosis curve after 4-6 months, if the curve is already close to 25
degrees, and the patient has a significant amount of growth left.
The rigid brace does not improve the curve, but aims to prevent further
curving of the spine.
A rigid plastic brace, called a CTLSO brace because it targets cervical, thoracic,
lumbar, and sacral orthosis, is fitted from the hips to the underarms and
surrounds the entire body.
Daytime and nighttime use is recommended.
Length of treatment is typically over two years.
MEDICAL MANAGEMENT
There are two main types of
braces:
Underarm: Made of plastic and
fitting close to the body, this brace
is virtually invisible. It’s used to
treat lower spine curves and fits
around the lower part of the body.

Milwaukee: This brace starts at
the neck and covers the entire
torso, with the exception of the
legs and arms. It’s used for curves
that the underarm brace can’t
address.
MEDICAL MANAGEMENT

2. Manual Therapy includes both

chiropractic treatment and
massage.
MEDICAL MANAGEMENT

3. Physical Therapy/Exercises
focuses on changing body
mechanics to improve posture and
walking as well as to strengthen
and retrain muscles.
Other techniques that physical
therapists may use are manual
treatments such as massage and
electro-stimulation through a TENS
(transcutaneous electrical nerve
stimulation) unit.
MEDICAL MANAGEMENT
4. Medications
- Acetaminophen, NSAIDS
- Muscle relaxants such as Flexeril,
Soma, Baclofen, Robaxin, and
Tizanidine
- Nerve membrane stabilizers such as
Gabapentin (Neurontin) and Lyrica
(Pregabalin)
- Off label medications for pain are
anti-depressant such as Cymbalta and
Amitriptyline.
5. Epidural Steroid Injections
reduce pain by injecting steroid, or
anti-inflammatory, medication at a
specific level/levels in the spine. 
Steroid injections are only safe to
have completed 3 times in one
year and must be at least one
month apart between sequential
injections.
SURGICAL MANAGEMENT
Transverse Lumbar Interbody
Fusion (TLIF) is a minimally
invasive stabilization procedure
that uses a specialized implant to
fix the appropriate disc level. This
procedure is performed through a
small incision on the midline of
the lumbar spine.
SURGICAL MANAGEMENT

An Extreme Lateral Lumbar

Interbody Fusion (XLIF) is a
minimally invasive surgery that is
performed on the lumbar spine. A
small incision is made on the left
side, between the hip and the
ribs.
NURSING DIAGNOSIS &
MANAGEMENT
1. Ineffective Breathing Pattern
Nursing Interventions:
> Assess respiratory status every 4 hours.
Rationale: Scoliosis hinders the movement of the ribs, therefore weakens the
respiratory muscles causing an increase in the work of breathing during, rest,
activity or at sleep.
> Assess oxygen saturation and pulse rate by using pulse oximetry.
Rationale: Pulse oximetry is a helpful tool to detect alterations in oxygenation.
> Monitor intake and output.
Rationale: Adequate hydration mobilizes secretions and prevents infection.
NURSING DIAGNOSIS & MANAGEMENT

> Auscultate breath sounds at least every 4 hours.

Rationale: This is to detect decreased or adventitious breath sounds.
> Assist the patient in doing deep breathing exercises.
Rationale: Deep breathing exercises are initiated to improve lung function.
> Place the client in a semi-Fowler position.
Rationale: Facilitates expansion of the lungs.
> Frequently reposition the patient every 2 hours.
Rationale: Promotes lung field inflation.
> Administer oxygen as needed.
Rationale: Oxygen increases peripheral oxygen saturation by 95%–100%
NURSING DIAGNOSIS &
MANAGEMENT
2.Impaired Physical Mobility
Nursing Interventions:
> Assess client’s description of pain using PQRST method.
Rationale: Severe curvature of the spine creates  stress and pressure on the spinal
discs,  muscles, nerves, and ligaments that can lead to pain.
> Assess the level of physical mobility.
Rationale: Understanding the particular level, guides the design of best possible
management plan.
> Assist the patient to perform active and passive range-of-motion exercises and regular
postural exercises.
Rationale: Promotes good circulation; helps maintain strength and muscle tone, and
these exercises may help in correcting the posture and managing the effects of scoliosis.
NURSING DIAGNOSIS & MANAGEMENT

> Assist the patient with the use of brace as indicated.

Rationale: The primary purpose of utilizing a brace is to prevent or slow
down the progression of the spinal curve.
> Collaborate with the physical therapist as indicated.
Rationale: Physical therapy uses corrective techniques in order to prevent
curve progression that enables continued maintenance and improvement
of quality of life.
NURSING DIAGNOSIS & MANAGEMENT

3. Disturbed Body Image

Nursing Interventions:
> Assess patient’s feelings on wearing brace, long-term treatments,
restricted movements, and inability to keep up with peers and participate in
activities.
Rationale: Provides information about the status of self-concept and
changes in appearance.
> Assist patient to adjust to self-perception of short leg, use of appliance
and effect on appearance.
Rationale: Promotes realistic perception of appearance and positive self-
image.
NURSING DIAGNOSIS & MANAGEMENT

> Assist with the plan for independence in performing ADL, application

and removal of appliance, choice of shoes and clothing to wear.
Rationale: Promotes independence and adjustment to the appliance.
> Assist patient to the type of clothing to cover appliance that is stylish
and has peer acceptance.
Rationale: Improves appearance and body image.
NURSING DIAGNOSIS & MANAGEMENT

4. Fatigue
Nursing Interventions:
> Assess the patient’s degree of fatigability by asking to rate his/her
fatigue level (mild, moderate, or severe).
Rationale: To create of activity levels and degree of fatigability.
> Provide comfort measures such as judicious touch or massage, and
cool showers.
Rationale: To reserve energy levels and provide optimal comfort and
relaxation.
NURSING DIAGNOSIS & MANAGEMENT

> Assist in performing deep breathing exercises and relaxation

techniques. Provide adequate ventilation in the room.
Rationale: To allow the patient to relax while at rest. To allow enough
oxygenation in the room.
> Refer the patient to physiotherapy/occupational therapy team as
required.
Rationale: To provide a more specialized care for the patient in terms of
helping him/her build confidence in balancing daily physical activity and
rest periods.
NURSING DIAGNOSIS & MANAGEMENT

5. Acute Pain
Nursing Interventions
> Assess the patient’s vital signs. Assess the pain from 0-10 or using PQRST
method.
Rationale: To create a baseline set of observations for the patient.
> Reposition the patient in his/her comforatable/preferred position. Assist the
patient in performing pursed lip breathing or deep breathing exercises.
Rationale: To promote optimal patient comfort and reduce anxiety/restlessness.
> Provide diversional activities such as music therapy, reading a book, watching
TV.
Rationale: To divert attention and help alleviate pain.
NURSING DIAGNOSIS & MANAGEMENT

> Provide massage to the affected part.

Rationale: To provide symptom relief.
> Provide analgesics as prescribed.
Rationale: To promote pain relief and patient comfort.
> Refer the patient to a pain specialist if ordered by the medical provider.
Rationale: To enable the patient to receive more information and
specialized care in pain management if needed.
COMPLICATIONS
1. Lung and heart damage. In severe scoliosis, the rib cage may press
against the lungs and heart, making it more difficult to breathe and harder
for the heart to pump.
2. Back problems. Adults who had scoliosis as children are more likely to
have chronic back pain than are people in the general population.
3. 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.
REFERENCES
Internet Based
Baaj, Ali. (2017). “Types of Scoliosis”, Spine Health. Retrived from https://www.spine-
health.com/conditions/scoliosis/types-scoliosis, Accessed on June 15, 2021.
Cassoobhoy, A. (2021). “Everything you need to know about scoliosis”, Healthline. Retrived from
https://www.healthline.com/health/scoliosis, Accessed on June 15, 2021.
Greaux, A. (2019). “Structural Scoliosis vs. Nonstructural Scoliosis”, Clear Scoliosis Institute. Retrieved from
https://clear-institute.org/blog/structural-scoliosis-vs-nonstructural-scoliosis/, Accessed on June 15, 2021.
Greaux, A. (2019). “Types of Scoliosis”, Clear Scoliosis Institute. Retrieved from https://clear-
institute.org/learning-about-scoliosis/types-of-scoliosis/, Accessed on June 15, 2021.
Mayo Clinic. (2019). “Scoliosis”, Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-
conditions/scoliosis/symptoms-causes/syc-20350716, Accessed on June 15, 2021.
Preferred Surgicenter. “Scoliosis”, Preferred Surgicenter. Retrieved from
https://preferredsc.com/spine/disease/scoliosis/, Accessed on June 15, 2021.
Sinicropi, S. (2021). “5 Common Causes of Scoliosis”, Dr. Stefano Sinicropi, MD. Retrived from
https://sinicropispine.com/5-common-causes-of-scoliosis/, Accessed on June 15, 2021.
Wheeler, T. (2020). “Scoliosis”, WebMD. Retrieved from https://www.webmd.com/back-pain/causes-scoliosis,
Accessed on June 15, 2021.
REFERENCES

Book Based
Doenges, M., Moorhouse, M., Murr, A. (2009). Nurse’s Pocket Guide.
Philadelphia.: F.A. Davis Company.

Smith, T. (2000). The British Medical Association Complete Family Health

Guide. Strand, London.: A Penguin Company.

Udan, J.Q. (2017). Medical Surgical Nursing Concepts and Clinical

Applications 3rd Edition. Ermita, Manila.: APD Educational Publishing House.