1. SCOLIOSIS  Three dimensional deformity involving rotation of the vertebral bodies  Causes the rib cage to become misshapen  Body develops a compensatory curve to maintain posture and balance  Nonstructural scoliosis does not involve rotational or muscular deformity due to poor posture

2. Degrees  10 to 20 a slight curve  More than 40% curve requires surgery  More than 80% compromises respiratory function and is considered severe

3. Clinical Manifestations  Visible curve of the spine  A rib hump when bending forward  Asymmetric rib cage  Uneven shoulder or pelvic heights  Prominence of scapula or hip  Difference in space between arms and trunk when standing  Apparent leg-length discrepancy

4. Diagnostic Evaluation  Routine scoliosis screening  Radiographic examination

5. Management  Regular and periodic observation with radiographic evaluation  Bracing  Spinal fusion surgery  Body image – talk about diagnosis, treatment, and feeling about experience  Discuss activities – school or activities  Notify school nurse

6. Bracing  Worn 18-23 hours a day  Wear 100% cotton, seamless T-shirt  Proper skin care  Clean inside/outside of brace daily  Notify HCP – numbness tingling of arms, leg, feet, cracks or breaks in brace, skin problems, respiratory problems

7. SURGERY  Curvature > 45 degrees  Spinal fusion with internal instrumentation  Delayed as long as possible to allow maximum skeletal growth  Most common posterior fusion  Iliac bone graft can be used for the fusion

8. Spinal Fusion  Neurovascular checks – 6 P’s  Log rolling every 2 hours  Pulmonary toileting  Wound care  Pain – PCA pump  Rule out complications – neurological status lower extremities, fluid status, bleeding, return of bowel function

9. Discharge teaching  Wound care  Importance of well balanced diet  Activity restrictions (Orthoplast jacket)  Report to HCP – skin breakdown, wound infection, numbness/tingling extremities, difficulty breathing  Provide information about National Scoliosis Associations