Scoliosis  A lateral curvature of the spine, may be found in thoracic, lumbar, or thoracolumbar spinal segment.

 The curve may be convex to the right (more common in lumbar curves) or to the left (more common in lumbar curves).  Rotation of the vertebral column around its axis occurs and may cause rib cage deformity.  It is often associated with kyposis (humpback) and lordocis (swayback).

Discovered Scoliosis: Hippocrates is widely credited as first discovering scoliosis around 500 BC. Scoliosis, a sideways spinal curvature, can be syndromic or idiopathic. Syndromic scoliosis can be attributed to a disease, while the idiopathic variety has no known cause. Most cases are idiopathic.

Assessment 1. Poor posture, uneven shoulder height. 2. One hip more prominent than the other. 3. Scapular prominence. 4. Uneven waist line or hemline 5. Spinal curve observable or palpable on both upright and bent forward. 6. Back pain may be present but is not a routine finding in idiopathic scoliosis. 7. Leg length discrepancy. Nursing Diagnosis  Disturbed body image related to negative feelings about spinal deformity and appearance in brace.  Risk for impaired skin integrity related to mechanical irritation to brace.  Risk for injury related to postoperative complications. Diagnostic Procedure 1. X-ray of the spine in the upright position, preferably on one long 36-inch cassette, show characteristic curvature. 2. MRI, myelograms, or CT scan with three dimensional reconstruction may be indicated for children with severe curvatures who have a known or suspected spinal column anomaly, before management decisions are made. 3. Pulmonary function tests for compromised respiratory status. 4. Evaluate for renal abnormalities in children with congenital scoliosis. Nursing Interventions 1. Prepare the child for casting or immobilization procedure by showing materials to be used and describing procedure in age-appropriate terms. 2. Promote comfort with proper fit of brace or cast. 3. Provide opportunity for the child to express fears and ask questions about deformity and brace wear. 4. Assess skin integrity under and around the brace or cast frequently. 5. Provide good skin care to prevent breakdown around any pressure areas. 6. Instruct the patient to examine brace daily for signs of loosening or breakage.

7. Instruct patient to wear cotton shirt under brace to avoid rubbing. 8. Instruct about which previous activities can be continued in the brace. 9. Provide a peer support person when possible so the child can associate positive outcomes and experiences from others.