Topic Of Presentation
Kyphoscoliosis
By
DR S. B. SULEHRIA
Assistant Professor
East Medical Ward
KEMU/Mayo hospital
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CASE SCENARIO

A 70 years old healthy looking Caucasian female
presented with complaints of

progressive loss of standing balance, severe back
pain and buttock pain, and moderate neurogenic
claudication.
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DEFINITION

Kyphoscoliosis is a combination of two
thoracic deformities that commonly appear
together.


Kyphosis is a posterior curvature of the spine
(humpback).
In scoliosis the spine is curved to one side—
typically appearing as an S or C shape.
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A
B
Figure 24-1. Kyphoscoliosis. Posterior and lateral curvature of the spine causing lung
compression. Excessive bronchial secretions (A) and atelectasis (B) are common
secondary anatomic alterations of the lungs.
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ETIOLOGY
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Etiology (Cont’d)

Idiopathic scoliosis is classified as follows:

Infantile scoliosis
• The curvature of the spine develops during the first 3
years of life.

Juvenile scoliosis
• The curvature occurs between 4 years and the onset of
adolescence.

Adolescent scoliosis
• The spine curvature develops after the age of 10.
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Etiology (Cont’d)

Risk Factors Include:



Sex—Girls are more likely to develop curvature of
the spine than boys.
Age—The younger the child is when the diagnosis
is first made, the greater the chance of curve
progression.
Angle of the curve—The greater the curvature of
the spine, the greater the risk that the curve
progression will worsen.
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Diagnosis

Scoliosis is diagnosed by means of the
patient’s medical history, physical
examination, x-ray evaluation, and curve
measurement.
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Diagnosis (Cont’d)

Clinically, scoliosis is commonly defined
according to the following factors related to
the curvature of the spine:




Shape
Location
Direction
Angle
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MANIFESTATIONS




Lung restriction and compression as a result
of the thoracic deformity
Mediastinal shift
Mucous accumulation throughout the
tracheobronchial tree
Atelectasis
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The Physical Examination

Vital signs


Increased
• Respiratory rate (tachypnea)
• Heart rate (pulse)
• Blood pressure
Cyanosis
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The Physical Examination, (Cont’d)



Digital clubbing
Peripheral edema and venous distention
Cough and sputum production
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The Physical Examination, (Cont’d)

Chest Assessment Findings







Obvious thoracic deformity
Tracheal shift
Increased tactile and vocal fremitus
Dull percussion note
Bronchial breath sounds
Whispered pectoriloquy
Crackles, rhonchi, and wheezing
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Clinical Data Obtained from
Laboratory Tests and Special
Procedures
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Pulmonary Function Test Findings
Moderate to Severe
(Restrictive Lung Pathophysiology)
Forced Expiratory Flow Rate Findings
FVC

FEF50%
N or 
FEVT
N or 
FEV1/FVC ratio
N or 
FEF200-1200
N or 
FEF25%-75%
N or 
PEFR
MVV
N or 
N or 
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Pulmonary Function Test Findings
Moderate to Severe
(Restrictive Lung Pathophysiology)
Lung Volume & Capacity Findings
VT
N or 
IRV

ERV

RV

IC
FRC
TLC
RV/TLC ratio



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VC

N
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Arterial Blood Gases
(Mild to Moderate Kyphoscoliosis)
Acute Alveolar Hyperventilation with Hypoxemia
(Acute Respiratory Alkalosis)
pH

PaCO2

HCO3
 (slightly)
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PaO2

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PaO2 and PaCO2 trends during acute alveolar hyperventilation.
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Arterial Blood Gases
(Severe Kyphoscoliosis)
Chronic Ventilatory Failure with Hypoxemia
(Compensated Respiratory Acidosis)
pH
N
PaCO2

HCO3
 (Significantly)
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PaO2

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PaO2 and PaCO2 trends during acute or chronic ventilatory failure.
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Arterial Blood Gases
Acute Ventilatory Changes Superimposed
On
Chronic Ventilatory Failure

Because acute ventilatory changes are frequently
seen in patients with chronic ventilatory failure, the
respiratory care practitioner must be familiar with and
alert for the following:

Acute alveolar hyperventilation superimposed on chronic
ventilatory failure

Acute ventilatory failure (acute hypoventilation)
superimposed on chronic ventialtory failure.
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Oxygenation Indices
(Moderate to Severe Kyphoscoliosis)
QS/QT

DO2

VO2
N
C(a-v)O2

O2ER

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SvO2

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Hemodynamic Indices
Moderate to Severe Kyphoscoliosis
CVP

RAP

PA

PCWP
N
CO
N
SV
N
SVI
N
CI
N
RVSWI

LVSWI
N
PVR

SVR
N
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Laboratory Findings

Severe and/or Late Stage Kyphoscoliosis

If the patient is chronically hypoxemic
• Increased hematocrit and hemoglobin (polycythemia)
• Hypochloremia (Cl-)
• Hypernatremia (Na+)
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Radiologic Findings

Chest Radiograph

Blunting thoracic deformity

Mediastinal shift
Increased lung opacity
Atelectasis in areas of compressed (atelectatic) lungs
Enlarged heart (cor pulmonale)



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Figure 24-3. Severe kyphoscoliosis in a 14-year-old male patient.
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MANAGEMENT
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General Management of Scoliosis
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

The treatment of scoliosis largely depends on the
cause of the scoliosis, the size and location of the
curve, and how much more growing the patient is
expected to do.
In most cases of scoliosis (less than 20 degrees), the
degree of abnormal spine curvature is relatively small
and requires only observation to ensure that the
curve does not worsen.
Observation is usually recommended in patients with
a spine curvature of less than 20 degrees.
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General Management of Scoliosis
(Cont’d)


In young children who are still growing,
observation checkups are usually scheduled
in 3- to 6-month intervals.
When the curve is determined to be
progressing to a more serious degree (above
25 to 30 degrees in a child who is still
growing), the following treatments options are
available:
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General Management of Scoliosis
(Cont’d)

Braces



Boston brace
Charleston bending brace
Milwaukee brace
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Figure 24-4 Common types of braces for scoliosis. A, Boston back brace (also called a thoraco-lumbrosacral-orthosis [TLSO], a low-profile brace, or an underarm brace). Typically used for curves in the lumbar
(low-back) or thoracolumbar sections of the spine. B, Charleston bending brace (also known as a part-time
brace). C, Milwaukee brace (also called cervicothoracolumbosacral orthosis [CTLSO]) is used for high
thoracic (mid-back) curves.
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General Management of Scoliosis
(Cont’d)



Surgery
Spinal fusion
Rod Instrumentation
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Figure 24-5 Radiograph of patient with scoliosis treated with a Harrington rod.
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General Management of Scoliosis
(Cont’d)

Other Approaches

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Some physicians may try electrical stimulation of
muscles, chiropractic manipulation, and exercise
to treat scoliosis.
There is no evidence that any of these procedures
will stop the progression of spine curvature.
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General Management of Scoliosis
(Cont’d)

Other Approaches (Cont’d)


Exercise, however, may improve the patient’s
overall health and well-being.
Prophylactic deep breathing and coughing (DB&C)
exercises are also taught.
• Their long-term effect is debatable.
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Respiratory Care Treatment
Protocols



Oxygen Therapy Protocol
Bronchopulmonary Hygiene Therapy Protocol
Lung Expansion Therapy Protocol
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