Kyphoscoliosis (Mod 1) Flashcards
Definition of Kyphoscoliosis
Combo of Scoliosis and Kyphosis
Scoliosis
S or C shaped curvature
- Structural (actual deformity) v.s Nonstructural (postural deformity)
- Severity of lung function varies
Define Kyphosis
Posterior curvature of the spine (hunchback)
What is the difference between Structural and nonstructural Scoliosis?
- Structural = A congenital disorder
- nonstructural scoliosis = postural and can be corrected…not an actual deformity
Etiology of Scoliosis
- Congenital
- Neuromuscular
- most commonly Idiopathic (infantile, juvenile, adolescent) Growth can progress/develop scoliosis as you get older
- Postural
Etiology of Kyphosis
- Degenerative diseases of the spine (arthritis)
- Fractures caused by oseteoporosis
- Slipping of vertebrae forward on another
- Other disorders (polio, spina, bifida)
Risk Factors for Kyphoscoliosis
- Gender;females more likely than males
- Genetics
- Age; younger age = greater risk of progression; working with gravity it will progress
- Angle of the Curve -> Greater initial curve = greater risk of progression
- Location; Upper spine = greater risk of progression
- Height; taller people= greater risk of progression
- Spinal problems at birth
What are Anatomical alterations bc of Kyphoscoliosis?
Restrictive Lung Pathology Lungs are literally being squished
- Alveolar Hypoventilation
- Atelectasis
- Weak cough leading to secretions
- Spirometry- All volumes decreased, RV/TLC ration remains normal
- ABG’s; Acute alveolar hyperventilation with hypoxemia or Chronic Ventilatory failure with hypoxemia
- Mediastinal shift
Diagnosis of Kyphoscoliosis
- Appearance and physical examination
- Spinal x-ray which identifies by examining curve measurement; specifically identifies the Cobb Angle
How will Kyphosis physically appear and what problems can be expected ?
Uneven shoulder height, prominence of scapula, uneven waste height, elevated hips, balance problems, pain (in the knees)
Sections of the spine?
- C7
- L12
- T5
General Management and Treatment for Kyphoscoliosis?
Management depends on cause, degree, and location of the curve, and timing of growth
- Observation (Cobb angle < 20), postural
- Bracing (25-45 deg)
- Surgery (Cobb angle >40-50 deg)
- Objective is to prevent worsening of the curve during growth
What is the primary treatment for idiopathic scoliosis?
Bracing (soft or hard shell)
What does surgery for scoliosis involve?
Instrumentation and fusion
- using the cortex duboisset technique
- Harrington rod method was used before infusions
Respiratory care treatment for patients with kyphoscoliosis
- Oxygen Therapy- Home oxygen, HHHFO (acute)
- Airway Clearance-Physical therapy, MIE, Manually
Assisted Cough, Bronchoscopy - Lung Expansion- MLVRM, LVRM
- Pneumonia- increased risk with lower lung volumes
- Pain management
Associated issues with Infantile Scoliosis
Shows up in infancy
- severe under 2 needing surgery and when they’re growing up rapidly, wee see curvatures really quickly
Optimal period to target therapies for Scoliosis?
Juvenile growth period to prevent curve from getting worst.
- Back braces would be the route since the patient is actively still growing
Why is adolescent Scoliosis more difficult to manage than juvenille?
Stabilized and quit growing.
- as you progress into adulthood some cases get worse as you age, most don’t bust sometimes it progresses
Postural Scoliosis therapies?
Physio can either fix or improve it
How severe is postural Scoliosis?
Never severe, its usually a mild curve that may not be noticed
Why is height a risk factor for Scoliosis?
Growing longer = more opportunity for the spine to curve
Is a upper spine or lower spine curve a higher risk for Scoliosis?
Upper spine/thoracic region = greater risk of progression
Which gender is at higher risk of developing Scoliosis?
Females: but male cases usually present as more severe though.
What organs would be affected by Scoliosis
The lungs and bowel could be squished by curves with Scoliosis.
- the spine can rotate as well when you get the “chicken wing” on your shoulder
- aka mediastinal shift on cxr
