1 Scoliosis Screening American Red Cross A Guide for School Nurses

2 Normal Spinal Curvature There are 4 natural curves in the vertebral column American Red Cross

3 Linear Spinal Curvatures KyphosisLordosis Spine curves backward in the chest area “Hunchback” Spine curves forward at the waist “Swayback” American Red Cross

4 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 American Red Cross

5 Degrees of Curvature Scoliosis 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 American Red Cross

6 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 American Red Cross

7 Diagnosis Physician Physical Exam Scoliometer measurements X Ray MRI American Red Cross

8 Incidence  10% of population will have some degree of adolescent curvature  Affects approx 1 million children in the US 3-5 out of every 1,000 cases are severe enough to require treatment 25% 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 visits 30,000 children are treated with a brace 38,000 undergo spinal surgery American Red Cross

9 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 American Red Cross

10 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 American Red Cross

11 Scoliosis Facts Race, ethnic background & socioeconomics do not appear to be factors Tends to occur in families Usually painless and without symptoms Child 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 American Red Cross

12 Girls Vs Boys  Primary age of onset 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. American Red Cross

13 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 **