Scoliosis Screening
A Guide for School Nurses
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Normal Spinal Curvature
There are
4 natural curves
in the vertebral column
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Linear Spinal Curvatures
Kyphosis
Spine curves backward
in the chest area
“Hunchback”
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Lordosis
Spine curves forward
at the waist
“Swayback”
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Scoliosis
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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
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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
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Causes of Scoliosis
Congenital
Problem with the formation of vertebrae or
fused ribs during prenatal development
Present at birth
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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
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Idiopathic
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Structural spinal curvature with no established cause
Appears in a previously straight spine
80-85% of cases
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Diagnosis
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Physician Physical Exam
Scoliometer measurements
X Ray
MRI
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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
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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
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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
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Scoliosis Facts
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Race, ethnic background & socioeconomics
do not appear to be factors
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Tends to occur in families
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Usually painless and without symptoms
Child is generally unaware of curvature
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Untreated scoliosis of greater than 30 degrees can lead to back pain in adults
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60 % of curvatures in rapidly growing prepubertal children will progress
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Increased risk for osteoporosis & gall bladder problems later in life
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Poor nutrition may play a role
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Girls Vs Boys
 Primary age of onset 10-15 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.
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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 **
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