1 Scoliosis Screening American Red Cross A Guide for School Nurses.

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Scoliosis Screening

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A Guide for School Nurses

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Normal Spinal Curvature

There are 4 natural curves in the vertebral

column

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Linear Spinal Curvatures

Kyphosis Lordosis

Spine curves backward

in the chest area“Hunchback”

Spine curves forward at the waist“Swayback”

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Scoliosis

Sideways curvature of the spine

Spine turns on its axis like a corkscrew

Normal spine has a “l” appearance

Scoliosis produces an “S” or “C” appearance

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Degrees of CurvatureScoliosis is a lateral deviation of the normal vertical line of the spine which, when measured by an X-ray, is greater than 10 degrees.

MILD

MODERATE

SEVERE

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Causes of Scoliosis

Congenital Problem with the formation of vertebrae or

fused ribs during prenatal development Present at birth

Neuromuscular, Connective Tissue & Chromosomal Abnormalities

Caused by a neurological disorder of CNS or muscular weakness Cerebral palsy, Muscular dystrophy, Spina bifida, Paralysis Marfan’s Syndrome Down’s syndrome

Idiopathic Structural spinal curvature with no established cause Appears in a previously straight spine 80-85% of cases

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Diagnosis Physician Physical Exam Scoliometer measurements X Ray MRI

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Incidence

10% of population will have some degree of adolescent curvature

Affects approx 1 million children in the US3-5 out of every 1,000 cases are severe enough to require treatment25% will require medical attention to monitor for progression

YEARLY in the US (all forms)Affects 2-3% of the general population- 6 million

600,000 physician office visits30,000 children are treated with a brace 38,000 undergo spinal surgery

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Scoliosis Mythology Scoliosis can be caused by carrying heavy book bags, poor posture

or sleeping on a bad mattress

Sports favoring one side can cause scoliosis

Lower back pain in adolescents is an indicator for scoliosis

Scoliosis always progresses and requires some form of treatment

Scoliosis is similar to osteoporosis in it’s destruction of the bone

Scoliosis is usually painful

Minor leg inequality will lead to scoliosis

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Weighing In on the Back Pack

Issue

Children should carry no more than 10-15% of their body weight in a backpack.

Backpack should be worn on BOTH shoulders to evenly distribute the weight

Heaviest books should be closest to the back

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Scoliosis Facts Race, ethnic background & socioeconomics

do not appear to be factors

Tends to occur in families

Usually painless and without symptomsChild is generally unaware of curvature

Untreated scoliosis of greater than 30 degrees can lead to back pain in adults

60 % of curvatures in rapidly growing prepubertal children will progress

Increased risk for osteoporosis & gall bladder problems later in life

Poor nutrition may play a role

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Girls Vs Boys

Primary age of onset 10-15 years During the last major growth spurt of adolescence

Time of greatest risk: Girls: 6 months before & after onset of menstruation Boys: Time when their voices deepen risk

Mild scoliosis occurs equally between boys and girls (?)1 in 10 girls vs 1 in 25 boys

More serious curves (<30 degrees) are 8-10X greater in girls than in boys.

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Scoliosis Treatment**Treatment is not needed for the vast majority of cases**Observation:

•Minor curvatures (>20 degrees)•Skeleton is close to maturity•Exercises may help with surrounding muscular strength

Brace:•Around torso and hips•Helps hold spine in place while it grows•Can be removed for sports

Surgery:•Major curvatures (<45 degrees)•Rapid deterioration/progression•Generally spinal fusion**Generally physical therapy/exercises are not effective **