Scoliosis
using bone grafts and metal rods and screws
 /sko-lee-oh-sus/ Greek word =crooked
 sideways curve of your backbone, or spine.
 often S- or C-shaped.
 Scoliosis is most common in growth spurts.
 Girls prone
 Hereditary
Cause:
• Nonstructural, which is when the spine is
structurally normal and the curve is
temporary.
• Structural, which is when the spine has a
fixed curve. The cause could be a disease,
injury, infection, or birth defect.
Signs:
*Idiopathic scoliosis can go unnoticed in a child
because it is rarely painful in the formative
years.Parents should watch for the following warning
signs of scoliosis when their child is about 8 years of
age:
• Uneven shoulders
• Prominent shoulder blade or shoulder
blades
• Uneven waist
• Elevated hips
• Leaning to one side
Diagnosis:
 medical and family history
 physical exam
 x ray
-lets the doctor measure the curve in
degrees (such as 25 degrees) and see its
location, shape, and pattern.
Treatment for scoliosis is based on:
 The person's age
 How much more he or she is likely to grow
 The degree and pattern of the curve
 The type of scoliosis.
1. Observation
 check every 4 to 6 months to see if the
curve is getting better or worse
 Used for those who have a curve of less
than 25 degrees and are still growing.
2. Bracing
 The person is still growing and has a curve
of more than 25 to 30 degrees.
 The person is still growing and has a curve
between 20 and 29 degrees that is getting
worse.
 The person has at least 2 years of growth
remaining and has a curve that is between
20 and 29 degrees. If a girl, she should not
have started having her monthly periods yet.
3. Surgery
 when the person is still growing
 the curve is more than 45 degrees
 the curve is getting worse
Spinal Fusion
- two or more vertebrae are fused together,
Spinal fusion is used to treat:
• Injuries to spinal vertebrae
• Protrusion and degeneration of the
cushioning disk between vertebrae
(sometimes called slipped disk or herniated
disk)
• Abnormal curvatures of the spine (such as
scoliosis or kyphosis)
• Weak or unstable spine caused by infections
or tumors
Spinal fusion
 eliminates motion between vertebral
segments, may cause pain.
 stops the progress of spinal deformity, such
as scoliosis.
 will take away some spinal flexibility
Technique:
Bone Grafting
 most commonly used material to help
promote fusion of the vertebrae.
 small pieces of bone are placed into the
space between the vertebrae to be fused
 larger solid pieces are used to provide
immediate structural support.
 The bone is either supplied by the patient
(autogenous bone) or harvested from other
individuals (allograft bone).
*Autogenous bone is generally better at promoting
fusion, but it requires extra surgery to remove bone
from the patient's hip.
Immobilization
 Bones are immobile with metal rods and
screws
 External bracing or casting may also be
used (can be both)
The 4 Components Orthopaedic Evaluation
1. Medical history - information about pt’s
general health and symptoms
2. Physical examination - to assess the
stability, strength, alignment and motion of your
back, as well as a neurologic evaluation
3. Diagnostic tests (radiography)
(X-rays), which may be
obtained to evaluate the bones and
structure of your spine
MRI (magnetic resonance
imaging) to provide more detailed
information about the spine and
uses no radiation to
create images.
 Myelography uses X-ray
imaging and an injected dye to
define bony and soft-tissue
structures affecting the nerve root
CT (computed tomography) may
also be arranged; CT provides
details about the bones
and soft tissues not seen on
regular X-rays
Recovery at Home
 Arrange for transportation home that will
allow the pt. to ride in a leaning back or lying
down position
 Pt. may do as much for himself as you can
as long as you maintain a balanced position
of your spine

 Pt. should not stay in bed during the day

4. Discussion - findings of the physical
examination and diagnostic evaluation and the
treatment for pt’s condition
Pre-OP care
1. Medication- stop taking certain medicine
 may interfere with or affect the results of
surgery
 may cause bleeding
 may interfere with the effects of your
anesthesia
 aspirin and nonsteroidal anti-inflammatory
drugs
2. Donating Blood
 blood loss may occur during surgery
 doctor may prescribe an iron supplement
to help build up your blood before surgery
 Teach the pt. not hesitate to ask for help
from your family members or friends if it is
needed
Wound Care
 stitches(sutures) or staples will be removed
approximately 2 weeks after surgery
 If the wound is clean and dry, no bandage is
needed.
 If drainage continues after you are home,
the wound should be covered with a
bandage and a call made to pt’s surgeon
Diet
Some loss of appetite is common. Eating well-
balanced meals and drinking plenty of fluids are
important

Advance Nursing Plan: Activity

Loss of energy is frequently experienced after major
 The pt. will be able to walk after surgery surgery, but this improves over time.

 Arrange for some help with washing, Initially, pt should only participate in walking
dressing, and household activities, such as
cleaning, laundry, and shopping, for a few Later, swim or use an exercise bike or treadmill to
days after your return home improve pt’s general physical condition

 Do not drive a car for a period of time after Avoiding Problems after Surgery
surgery.
Warning signs of possible blood clots include the
Nursing Considerations: following:
1. Immediate complications
 urinary retention • Swelling in the calf, ankle or foot
 temporary decreased or absent intestinal • Tenderness or redness, which may extend
function above or below the knee
2. Major complications • Pain in the calf
 Heart attack
 Stroke *a blood clot may travel through the blood stream
 Infection & Blood clots- first few weeks after and may settle in your lungs (Pulmonary embolism)
surgery Symptoms:
 Recurrent disk herniations sudden chest pain and shortness of breath
or coughing
 nerve damage can result in pain and
prolonged recovery time
Infection following spine surgery occurs very rarely
Rehabilitation Warning signs of infection include:
 Pain medication will be given regularly, or
PCA • Redness, tenderness, and swelling around
the wound edges
 The fused spine must be kept in proper
alignment • Drainage from the wound
• Pain or tenderness
 Turn frequently using a "log rolling"
technique-move the entire body as a unit, • Shaking chills
avoiding twisting of the spine. • Elevated temperature, usually above 100°F
if taken with an oral thermometer
 Discharged from the hospital with a back
brace or cast.
After Recovery
 Weight reduction Program

 Exercise programs have not been shown

to keep scoliosis from getting worse.

 Weight-bearing exercise, such as

walking, running, soccer, and
gymnastics, helps keep bones strong
Alternative Treatments

So far, the following treatments have not been

shown to keep curves from getting worse in
scoliosis:
>Chiropractic treatment
>Electrical stimulation
>Nutritional supplements
>Exercise