M E S Assessment, Diagnosis, and Treatment of Pediatric ...
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Neuromuscular Scoliosis • Seen in neuromuscular disorders: -Deformities may be postural or structural and may progress rapidly -Duchenne muscular dystrophy -Spinal muscular atrophy -Cerebral Palsy -Myelodysplasia -Traumatic paralysis • Research has not proven that bracing is effective but may be helpful in positioning • Surgery may be indicated if severe progression • Do before pulmonary/cardiac complications occur • Children are often high risk surgical candidates Mary Sobralske, PhD, MSN, RN Assistant Professor of Nursing Certified Family Nurse Practitioner 509.324.7208 [email protected] References Akbarnia, B.A., Marks, D.S., Boachie-Adjei, O., Thompson, A.G., & Asher, M.A. (2005). Dual growing rod technique for the treatment of progressive early-onset scoliosis: A multicenter study. Spine, 30 (17 Supple), S46-57. Anderson, M.O., Christensen, S.B., & Thomsen, K. (2006). Outcome at 10 years after treatment for adolescent idiopathic scoliosis. Spine, 31(3), 350-354. Cheung, C.S, Lee, W.T., Tse, Y.K., Lee, K.M., Guo, X., Qin, L., et al. (2006). Generalized osteopenia in adolescent idiopathic scoliosis- association with abnormal pubertal growth, bone turnover, and calcium intake? Spine, 31(3), 330-338. Cobb, J.R. (1948). Outline for the study of scoliosis. In Instructional Course Lectures. The American Academy of Orthopaedic Surgeons, 5, 261-275. Dormans, J.P. (2005). Pediatric orthopaedics core knowledge in orthopaedics. Philadelphia, PA: Mosby. Greulich, W.W. & Pyle, S.I. (1959). Radiographic atlas of skeletal development of the hand and wrist (2nd ed.) Stanford, CA: Stanford University Press. Gillingham, B.L., Fan, R.A., & Akbarnia, B.A. (2006). Early onset idiopathic scoliosis. Journal of the American Academy of Orthopaedic Surgeons, 14 (2), 101-112. Haefeli, M., Elfering, A., Kilian, R. Min, K., & Boos, N. (2006). Nonoperative treatment for adolescent idiopathic scoliosis: A 10 to 60 year follow-up with special reference to health-related quality of life. Spine, 31(3), 355-366. Hart, E.S. & Grottkau, B.E. (2006, Feb.). Your important role in managing scoliosis. The Clinical Advisor, pp. 43-47. Helfenstein, A., Lankes, M., Ohlert, K., Varoga, D., Hahne, H.J., Ulrich, H.W., et al. (2006). The objective determination of compliance in treatment of adolescent idiopathic scoliosis with spinal orthosis. Spine, 31(3), 339-344. Karol, L.A. (2001). Effectiveness of bracing in male patients with idiopathic scoliosis. Spine, 26 (18), 2001-2005. Katz, D.E., & Durrani, A.A. (2001). Factors that influence outcome in bracing large curves in patients with adolescent idiopathic scoliosis. Spine, 26 (21), 2354-2361. Lenke, L.G. (2005). Lenke classification system of adolescent idiopathic scoliosis: Treatment recommendations. Instructional Course Lectures, 54, 537-542. Lenssinck, M.L. Frijlink, A.C., Berger, M.Y. Bierman-Zeinstra, S.M., Verkerk, K., & Verhagen, A.P. (2005). Effect of bracing and other conservative interventions in the treatment of idiopathic scoliosis in adolescents: A systematic review of clinical trials. Physical Therapy, 85(12), 1329-1339. Lonstein, J.E. (2006). Scoliosis: Surgical versus non-surgical treatment. Clinical Orthopaedics and Related Research, 443, 248-259. Magee, D.J. (2002). Orthopedic physical assessment (3rd ed). St. Louis, MO: Mosby. Murphy, N.A., Firth, S., Jorgenson, T. & Young, P.C. (2006). Spinal surgery in children with idiopathic and neuromuscular scoliosis. What’s the difference? Journal of Pediatric Orthopaedics, 26 (2), 216- 220. Reamy, B.V., & Slakey, J.B. (2001). Adolescent idiopathic scoliosis: Review and current concepts. American Family Physician, 64 (1), 111- 116. Risser, J.C. (1958). The iliac apophysis: An invaluable sign in the management of scoliosis. Clinical Orthopaedics 11, 111-119. Salter, R.B. (1999). Textbook of disorders and injuries of the musculoskeletal system (3rd ed). Philadelphia, PA: Lippincott Williams & Wilkins. Staheli, L.T. (2001). Practice of pediatric orthopedics. Philadelphia, PA: Lippincott Williams & Wilkins. Ugwonali, O.F., Lomas, G., Choe, J.C., Hyman, J.E., Vitale, M.G., & Roye, D.P. (2004). Effect of bracing on the quality of life of adolescents with idiopathic scoliosis. Spine, 4 (3), 254-260. The National Scoliosis Foundation http://www.scoliosis.org Scoliosis Research Society http://www.srs.org American Academy of Orthopaedic Surgeons http://www.aaos.org Diagnosing Scoliosis • Measure plumb line from T1 to gluteal cleft • Is head well balanced on pelvis? • Determine compensation of spinal curves • Adams bend test - most reliable • Scoliometer reading over vertebral prominences • Focused neurological exam • Skin assessment Treatment • 20-25° consider bracing if rapid progression -Bracing not as effective in males (Karol, 2001; Katz & Durrani, 2001) -Follow-up every 4-6 months • Bracing indicated if still growing and >25° curve -Boston brace -Charleston brace -Providence brace • Surgery >45° curvature if skeletally mature Five Sisters with Scoliosis Adolescent Idiopathic Scoliosis • Adolescent (10 years to end of growth) • Most common type (80-90%) • Frequency 1.9-3% (25 in 1,000) • Typically right sided thoracic curve, left lumbar if 2nd curve • Underlying etiology unclear • Family history in 30% • No specific gene or mode of inheritance identified • Females: more severe forms, Males: 25% incidence intrathecal abnormalities • Future growth potential • Curve magnitude and progression • Progression of 5 or more degrees often coincides with growth spurt of puberty • Larger curves more likely to progress Congenital Scoliosis • Lateral curvature of spine caused by vertebral anomalies • May have associated renal and cardiac anomalies Renal ultrasound recommended Peds cardiac evalueformity may not be detected until later in life • Some anomalies never produce deformity and are never detected • CT with 3D reconstruction best assessment tool for surgical planning 3D reconstruction of lumbar spine Vertebral Anomalies Wedge Vertebra Partial unilateral failure of formation Hemivertebra Complete unilateral failure of formation Congenital Bar Unilateral failure of segmentation Block Vertebra Bilateral failure of segmentation C OBB A NGLE Assessing Scoliosis • Scoliosis is a lateral curvature of the spine >13° by Cobb method accompanied by vertebral rotation - most common pediatric disorder of the spine • Idiopathic—Infant, Juvenile, Adolescent • Congenital • Neuromuscular • Connective tissue • Degenerative (adults) • Scoliosis is associated with syndromes such as Marfans Assessment, Diagnosis, and Treatment of Pediatric Scoliosis: Mary Sobralske, PhD, MSN, RN { A N EDUCATIONAL METHOD FOR T EACHING WSU F AMILY N URSE P RACTITIONER S TUDENTS } Cobb Angle Infantile Scoliosis • In children under 3 years it may be idiopathic • Thought to be positional deformity because it is often associated with plagiocephaly and hip dysplasia • Usually spontaneous resolution occurs when < 20° • In some cases, it is secondary to underlying spinal pathology; these curves progress. • If Cobb angle >20°, treat with bracing Juvenile Scoliosis • Onset age 3 to pre-puberty • Diagnosed when 4-9 years old • Seen in 12-21% scoliosis cases • Commonly progresses • Risk higher in females • In 25% cases, there is intraspinal pathology • Assess same as with adolescent idiopathic scoliosis • Note café-au-lait spots • Generally spine is flexible and responds to bracing • Consider MRI of spine to R/O intraspinal pathology C HRONIC B IOBEHAVIORAL N URSING O UTCOMES ...innovative method to educate students about new concepts through the use of multi-media illustrations of physical examination findings, radiographic images, surgical procedures, and corrective bracing .... “ ” nursing.wsu.edu © 2008 WSU Intercollegiate College of Nursing Graphic Design and Illustration—Susan Lyons
Transcript of M E S Assessment, Diagnosis, and Treatment of Pediatric ...
Neuromuscular Scoliosis• Seen in neuromuscular disorders:
-Deformities may be postural or structural and may progress rapidly
-Duchenne muscular dystrophy-Spinal muscular atrophy-Cerebral Palsy-Myelodysplasia-Traumatic paralysis
• Research has not proven that bracing is effective but may be helpful in positioning
• Surgery may be indicated if severe progression
• Do before pulmonary/cardiac complications occur
• Children are often high risk surgical candidates
Mary Sobralske, PhD, MSN, RN Assistant Professor of Nursing
Certified Family Nurse Practitioner
ReferencesAkbarnia, B.A., Marks, D.S., Boachie-Adjei, O., Thompson, A.G., &
Asher, M.A. (2005). Dual growing rod technique for the treatment of progressive early-onset scoliosis: A multicenter study. Spine, 30 (17 Supple), S46-57.
Anderson, M.O., Christensen, S.B., & Thomsen, K. (2006). Outcome at 10 years after treatment for adolescent idiopathic scoliosis. Spine, 31(3), 350-354.
Cheung, C.S, Lee, W.T., Tse, Y.K., Lee, K.M., Guo, X., Qin, L., et al. (2006). Generalized osteopenia in adolescent idiopathic scoliosis-association with abnormal pubertal growth, bone turnover, and calcium intake? Spine, 31(3), 330-338.
Cobb, J.R. (1948). Outline for the study of scoliosis. In Instructional Course Lectures. The American Academy of Orthopaedic Surgeons, 5, 261-275.
Dormans, J.P. (2005). Pediatric orthopaedics core knowledge in orthopaedics. Philadelphia, PA: Mosby.
Greulich, W.W. & Pyle, S.I. (1959). Radiographic atlas of skeletal development of the hand and wrist (2nd ed.) Stanford, CA: Stanford University Press.
Gillingham, B.L., Fan, R.A., & Akbarnia, B.A. (2006). Early onset idiopathic scoliosis. Journal of the American Academy of Orthopaedic Surgeons, 14(2), 101-112.
Haefeli, M., Elfering, A., Kilian, R. Min, K., & Boos, N. (2006). Nonoperative treatment for adolescent idiopathic scoliosis: A 10 to 60 year follow-up with special reference to health-related quality of life. Spine, 31(3), 355-366.
Hart, E.S. & Grottkau, B.E. (2006, Feb.). Your important role in managing scoliosis. The Clinical Advisor, pp. 43-47.
Helfenstein, A., Lankes, M., Ohlert, K., Varoga, D., Hahne, H.J., Ulrich, H.W., et al. (2006). The objective determination of compliance in treatment of adolescent idiopathic scoliosis with spinal orthosis. Spine, 31(3), 339-344.
Karol, L.A. (2001). Effectiveness of bracing in male patients with idiopathic scoliosis. Spine, 26(18), 2001-2005.
Katz, D.E., & Durrani, A.A. (2001). Factors that influence outcome in bracing large curves in patients with adolescent idiopathic scoliosis. Spine, 26(21), 2354-2361.
Lenke, L.G. (2005). Lenke classification system of adolescent idiopathic scoliosis: Treatment recommendations. Instructional Course Lectures, 54, 537-542.
Lenssinck, M.L. Frijlink, A.C., Berger, M.Y. Bierman-Zeinstra, S.M., Verkerk, K., & Verhagen, A.P. (2005). Effect of bracing and other conservative interventions in the treatment of idiopathic scoliosis in adolescents: A systematic review of clinical trials. Physical Therapy, 85(12), 1329-1339.
Lonstein, J.E. (2006). Scoliosis: Surgical versus non-surgical treatment. Clinical Orthopaedics and Related Research, 443, 248-259.
Magee, D.J. (2002). Orthopedic physical assessment (3rd ed). St. Louis, MO: Mosby.
Murphy, N.A., Firth, S., Jorgenson, T. & Young, P.C. (2006). Spinal surgery in children with idiopathic and neuromuscular scoliosis. What’s the difference? Journal of Pediatric Orthopaedics, 26(2), 216-220.
Reamy, B.V., & Slakey, J.B. (2001). Adolescent idiopathic scoliosis: Review and current concepts. American Family Physician, 64(1), 111-116.
Risser, J.C. (1958). The iliac apophysis: An invaluable sign in the management of scoliosis. Clinical Orthopaedics 11, 111-119.
Salter, R.B. (1999). Textbook of disorders and injuries of the musculoskeletal system (3rd ed). Philadelphia, PA: Lippincott Williams & Wilkins.
Staheli, L.T. (2001). Practice of pediatric orthopedics. Philadelphia, PA: Lippincott Williams & Wilkins.
Ugwonali, O.F., Lomas, G., Choe, J.C., Hyman, J.E., Vitale, M.G., & Roye, D.P. (2004). Effect of bracing on the quality of life of adolescents with idiopathic scoliosis. Spine, 4(3), 254-260.
The National Scoliosis Foundation http://www.scoliosis.orgScoliosis Research Society http://www.srs.orgAmerican Academy of Orthopaedic Surgeons http://www.aaos.org
Diagnosing Scoliosis• Measure plumb line from T1 to gluteal cleft• Is head well balanced on pelvis?• Determine compensation of spinal curves• Adams bend test
- most reliable• Scoliometer reading over vertebral
prominences• Focused neurological exam• Skin assessment
Treatment• 20-25° consider bracing if rapid progression
-Bracing not as effective in males (Karol, 2001; Katz & Durrani, 2001) -Follow-up every 4-6 months
• Bracing indicated if still growing and >25° curve -Boston brace -Charleston brace -Providence brace
• Surgery >45° curvature if skeletally mature
Five Sisters with Scoliosis
Adolescent Idiopathic Scoliosis
• Adolescent (10 years to end of growth)• Most common type (80-90%)• Frequency 1.9-3% (25 in 1,000)• Typically right sided thoracic curve,
left lumbar if 2nd curve• Underlying etiology unclear• Family history in 30%• No specific gene or mode of inheritance
identified• Females: more severe forms,
Males: 25% incidence intrathecal abnormalities
• Future growth potential• Curve magnitude and progression• Progression of 5 or more degrees often
coincides with growth spurt of puberty• Larger curves more likely to progress
Congenital Scoliosis• Lateral curvature of spine caused by
vertebral anomalies• May have associated renal and cardiac
anomalies Renal ultrasound recommended Peds cardiac evalueformity may not be detected until later in life
• Some anomalies never produce deformity and are never detected
• CT with 3D reconstruction best assessment tool for surgical planning
3D reconstruction of lumbar spine
Vertebral Anomalies
Wedge VertebraPartial unilateral failure
of formation
HemivertebraComplete unilateral failure
of formation
Congenital BarUnilateral failure of segmentation
Block VertebraBilateral failure
of segmentation
Co
bb
An
gl
e
Assessing Scoliosis• Scoliosis is a lateral curvature of the spine >13° by Cobb
method accompanied by vertebral rotation - most common pediatric disorder of the spine
• Idiopathic—Infant, Juvenile, Adolescent• Congenital• Neuromuscular• Connective tissue• Degenerative (adults)• Scoliosis is associated with syndromes such as Marfans
Assessment, Diagnosis, and Treatment of Pediatric Scoliosis:
Mary Sobralske, PhD, MSN, RN{An EducAtionAl MEthod for tEAching WSu fAMily nurSE PrActitionEr StudEntS}Cobb Angle
Infantile Scoliosis• In children under 3 years it may be idiopathic• Thought to be positional deformity because
it is often associated with plagiocephaly and hip dysplasia
• Usually spontaneous resolution occurs when < 20°
• In some cases, it is secondary to underlying spinal pathology; these curves progress.
• If Cobb angle >20°, treat with bracing
Juvenile Scoliosis• Onset age 3 to pre-puberty• Diagnosed when 4-9 years old• Seen in 12-21% scoliosis cases• Commonly progresses• Risk higher in females• In 25% cases, there is intraspinal pathology• Assess same as with adolescent idiopathic
scoliosis• Note café-au-lait spots• Generally spine is flexible and responds
to bracing• Consider MRI of spine to R/O intraspinal
pathology
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...innovative method to educate students about new concepts through the use of multi-media illustrations
of physical examination findings, radiographic images, surgical
procedures, and corrective bracing....
“
”
nursing.wsu.edu© 2008 WSU Intercollegiate College of NursingGraphic Design and Illustration—Susan Lyons
