Skeletal Disorders and Immobilization in the Pediatric Patient

Scoliosis refers to a 3-dimensional deformity of the spine, that includes a rotational and lateral curvature that resembles an “S” or “C” shape.

Now, scoliosis can be idiopathic, congenital, or neuromuscular. Idiopathic scoliosis is the most common type, which has no identifiable cause. On the other hand, congenital scoliosis develops due to abnormal intrauterine development of the spine and is present at birth. Lastly, neuromuscular scoliosis is associated with neuromuscular conditions like cerebral palsy, muscular dystrophy or atrophy, as well as spinal cord tumors and myelomeningocele.

Okay so, scoliosis typically becomes apparent during adolescence, during the physiological growth spurt. This is when the body grows at a faster rate, and sometimes the skeletal system doesn’t keep up, resulting in a skeletal deformity like scoliosis, where there’s an abnormal rotation of the vertebral bodies around their vertical axis. As a result, the affected vertebral bodies rotate to the side of the spine that is curved outward, eventually causing the spine to take the shape of a letter “S” or “C.” This curvature further causes chest deformation, rib displacement, and asymmetry of distant parts of the body.

Important complications include spinal stenosis, which is the narrowing of the spinal canal; pinched nerves; and altered body image that can impact the patient’s self-image and mental health. Additionally, abnormal anatomy of the chest can decrease pulmonary capacity and compromise respiratory as well as cardiac function.

Clinical manifestations of scoliosis primarily include asymmetry of the shoulder and hip height, as well as differences in leg lengths. Some patients might also have one prominent shoulder blade or a prominence on one side of the back when bending forward.

Diagnosis of scoliosis begins with the patient’s history and physical assessment. An X-ray is often used to determine the Cobb angle, which measures the severity of spinal deformity. A scoliometer can also be used to measure the Cobb angle, without an X-ray, by placing it over the spine and asking the patient to bend forward. A Cobb angle of more than 10 degrees usually indicates scoliosis. Finally, a CT and MRI might be needed for preoperative assessment of patients who require surgical intervention.

On a side note, screening for scoliosis is commonly performed during adolescence with the forward bend test, where the individual bends forward at the waist, with arms hanging freely, while the examiner visually inspects the spine and back for asymmetry and palpates the spine to check for abnormal curvatures.

Treatment is based on several factors, including the patient’s age, their predictive growth, presence of other conditions, and the degree and location of the curvature. Minor curvatures, meaning less than 25 degrees, can benefit from physical therapy. Curvatures from 25 to 40 degrees can be treated with thoracic lumbar sacral orthosis, which is a type of bracing. On the other hand, a curvature beyond 45 degrees typically requires surgical intervention, such as stapling, body tethering, or spinal fusion.

Alright, now let’s look at the nursing care you’ll provide for a patient with scoliosis. Your priority nursing goals are to monitor for cardiopulmonary complications, provide supportive care during treatment, and provide psychosocial support.