Scoliosis

Question 1

What is scoliosis?

Answer 1

Scoliosis is a lateral curvature in the vertebra with a resulting
deformity of the ribcage.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 904.

Question 2

What is kyphosis?

Answer 2

Kyphosis is a posterior curvature in the spinal column.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 653

Question 3

What are the five categories of scoliosis and which is

the most prevalent?

Answer 3

The five categories of scoliosis are based on their etiology.
They are: idiopathic, congenital, neuropathic, myopathic, and
traumatic. Neuropathic scoliosis is caused by diseases such as
polio, cerebral palsy, and syringomyelia. Myopathic scoliosis is
caused by conditions such as muscular dystrophy and
amyotonia. Idiopathic scoliosis is the most prevalent form.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 653.

Question 4

What treatment options are available for scoliosis?

Answer 4

Scoliosis may warrant observation without medical treatment,
the use of braces or electronic stimulator, and anterior or
posterior spinal fusion with rods.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 654.

Question 5

What degree of spinal curvature is considered

severe in patients with scoliosis?

Answer 5

A spinal curvature greater than 40 degrees is considered
severe scoliosis.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 452-453

Question 6

What preoperative diagnostic tests should be

performed in patients with severe scoliosis?

Answer 6

Pulmonary function tests, arterial blood gases, and ECG should
be performed in patients with severe scoliosis.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 904.

Question 7

What cardiovascular abnormalities typically

accompany severe scoliosis?

Answer 7

Mitral valve prolapse is the most common cardiac abnormality
associated with scoliosis. Pulmonary hypertension leading to
right ventricular hypertrophy is a common sequela as
progressive hypoxemia results in pulmonary vasoconstriction.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 654.

Question 8

What respiratory complications can accompany

kyphosis and scoliosis?

Answer 8

The severe chest wall deformity can result in a restrictive
respiratory pattern with a reduction in lung volumes with vital
capacity, total lung capacity, functional residual capacity, and
residual volume all reduced. V/Q mismatching with hypoxemia
can develop. Cor pulmonale is a common finding. Although
most patients are normally normocarbic, and elevated PaCO2
heralds impending ventilatory failure. The vital capacity is
typically reduced to 60-80% of the predicted value. The
FEV1/FVC is normal unless the patient’s condition is
complicated by concomitant pulmonary disease.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 653-654.

Question 9

Why might the use of nitrous oxide be discouraged
during the anesthetic for patients with severe
scoliosis?

Answer 9

Nitrous oxide may predispose the patient to increases in
pulmonary vascular resistance and could worsen pulmonary
hypertension.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 462-463.