NR 602 WEEK 2 GRAND ROUND- ADOLESCENT IDIOPATHIC SCOLIOSIS. Graded A

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Name NR 602 Adolescent Idiopathic Scoliosis Introduction: The following will be a presentation about Adolescent Idiopathic Scoliosis. The patient is a 12 y/o patient who comes in for an annual ... physical exam. The patient and patient’s mother denied any medical concerns and the only report is that she had her first period 5 months prior. The physical exam reveals no abnormal findings with the exception of a slight noted asymmetry of the shoulders. This may indicate that there is an abnormal posturing, or something is affecting the spine. In any event further investigation is needed. In order to determine what may be causing the asymmetry of the patients shoulder a more in depth physical examination is conducted. The patient is asked to remove her shoes and stand as she normally does; the patient is asked to take a few steps forward and her back and gait are observed. There is no abnormal gait, but her spine does appear to be minimally misaligned. These findings are strong indication that her spine is curving in an abnormal fashion. Scoliosis pathophysiology, epidemiology, and risks factors:The question is now, what is causing this change in her spine and what should we do about it. There are several factors that may be causing this but for now we will concentrate on three possibilities. First, she may be developing Scoliosis. This is a disorder that causes the spine to curve in an S shape of a C shape. The exact cause is unknown, and it can occur at any age during childhood and even in early adulthood. Adolescent Idiopathic Scoliosis usually develops between the ages of 10 to 15 years of age. Girls develop the disorder at a greater frequency in comparison to boys- 1.5:1 to 3:1, and progression of the curvature is more aggressive in girls in comparison to boys. For example, studies have showed that girls will reach skeletal maturity 1.5 years after menarche and it is during this time that the curvature will also increase. Therefore, it is imperative that close monitoring is maintained (Toye et al., 2016). Other factors that are believed to contribute to the disorder development are related to neurological disorder such Cerebral Palsy and Poliomyelitis, connective tissue disorders, musculoskeletal anomalies, and syndromes such as Marfan Syndrome and Ehlers-Danlos Syndrome just to mention some (Choudhry, Ahmad & Verma, 2016). Other possible diagnoses: A second possible cause for the anomaly may be related to a neoplasm pressing on the spine and a third possible cause may be related to musculoskeletal anomalies most often when one leg is longer than the other which will cause hip asymmetry which leads to pushing towards one side thus potentiating the change in shape. In either of these cases a more thorough evaluation is warrant thus x-rays, CT scan, and/or MRI studies would be necessary. For instance, a tumor may not be visualized with by doing an X-rays therefore, a CT scan or MRI would be necessary. On the other hand, an X-ray may be the only necessary test to determine hip asymmetry causes by an abnormal leg length. Diagnostics: The diagnosing of Scoliosis in the office can be done by combining a thorough medical and family history; and a thorough physical assessment which should include the Adam Bend Forward Test. This is the most common test done in an office setting to diagnose the disorder and is also the main diagnostic test recommended 2016 International Scientific Society on Scoliosis Orthopedic and Rehabilitation Treatment guidelines (SOSORT), (Negrini, et al., 2018). The Adam Forward Bending Test involves having the patient bend as far down as possible at the waist which will allow for visualization of the change in spinal curvature. In addition, for those with moderate or significant change in curvature a hump will be evident at the point where the spine shape is changing. In addition, a close observation will also reveal that the shape is not only changing but that there is also a change in the spine bone rotation (Grossman et al., 2018).X-ray of the lumbar spine can be ordered to assess for the degree of change in the curvature; the change in curvature can be determine by doing utilizing the Cobb angle measurement which was invented for this specific purpose by Dr. John Cobb in 1948. The angle measurement will dictate the treatment plan (International Journal of Spine Surgery 2017). No laboratory measurements are necessary to aid the diagnosis, but as mentioned CT scans and/or MRI may be necessary to rule out other pathologies. Prevention and Treament: There are no known preventive measures for this disorder, but it can be reversible if treated early employing the proper interventions. Studies have showed that curvatures presenting with a 20 degree or less change usually will resolve but the patient should be encourage to do stretching exercises, practice proper posturing. In addition, the clinician should maintain a frequent and close monitoring. However, once the curvature exceeds 20 degrees a treatment plan should be initiated. It is at this point when the patient will be referred to an orthopedic doctor who will initiate the proper interventions. The initial treatment depends on the severity of the curvature and on how fast the curve is progressing. It is imperative that the proper guidelines are follow. The American Academy of Pediatrics, the International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment, the Scoliosis Research Society, and the National Institute of Health provide guidelines and recommendations on treatment options for this condition. Although there are some differences in the recommendation details all are consisting in the three management optionsobservation, bracing, and surgical intervention. A curvature change of 25-45 degrees requires bracing and for those with a degree of more than 45 degrees surgery is necessary. Moreover, surgical choices also depend on degree of severity, and how aggressive the curve and is changing, and whether the patient will continue to grow, or growth is complete. Surgical intervention usually involves spinal fusion which is aiming to prevent curvature progression and to some degree correct the curvature as much as possible. Patient and family education: Living with Scoliosis can be challenging for patients and families. It is during adolescent years when the individual is more conscious about body image and it is during this time when kids are more involved in physical activities such as sports. It is important to provide support and education to the patient and to the parents. Treatment usually such as bracing requires a great deal of compliance from the patient and the care-giver. For example, it is recommended that a brace is wear 23 hours every day; this may be extremely difficult for the child not only emotional state but physically. The child may become depress or isolate his or herself because of feeling different or inadequate. In addition, the brace may be uncomfortable, may make sleeping difficulty, it may not allow for the child to wear his or her choice of clothing, may prevent the child from participating in peer activities and so forth. It is important to acknowledge all this concerns with the patient and the parent and while these are difficult issues to overcome; the patient and parent should be re-assured that the outcome would be a positive one. Applying and following the proper treatment plan should help the patient to resolve or significantly diminish the impairment. Discussion: This is an interesting disorder but, in my opinion, there is not enough awareness. Some of the literature and guidelines I reviewed provide thorough explanation in disease process and management but do not provide clear recommendations screening and community awareness. And as mentioned in our lecture and text the disorder is usually discovered by the parent or at school by school nurses. Also, there is evidence that there may be a genetic factor, but genetic studies aim to detect a link are limited. The questions what should be the consensus for screening? Should those with family history of Scoliosis receive genetic counseling? And should the provider include scoliosis screening for all children beginning in infancy regardless of risk factors?With these three questions I conclude my presentation and I look forward to continuing discussing the topic with all of you. Choudhry, M. N., Ahmad, Z., & Verma, R. (2016). Adolescent idiopathic scoliosis. The open orthopaedics journal, 10, 143. Grossman, D. C., Curry, S. J., Owens, D. K., Barry, M. J., Davidson, K. W., Doubeni, C. A., ... & Landefeld, C. S. (2018). Screening for Adolescent Idiopathic Scoliosis: US Preventive Services Task Force Recommendation Statement. Jama, 319(2), 165-172. Negrini, S., Donzelli, S., Aulisa, A. G., Czaprowski, D., Schreiber, S., de Mauroy, J. C., ... & Lebel, A. (2018). 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis and Spinal Disorders, 13(1), 3. Toye, F., Williamson, E., Williams, M., Fairbank, J., & Lamb, S. (2016). What matters to patients and their families in the management of adolescent idiopathic scoliosis? The Spine Journal, 16(4), S97.https://www.ncbi.nlm.nih.gov https://www.srs.org/search.php?Keywords=guideline [Show More]

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