Kyphoscoliosis



Kyphoscoliosis



Chapter Objectives


After reading this chapter, you will be able to:


• List the anatomic alterations of the lungs associated with kyphoscoliosis.


• Describe the causes of kyphoscoliosis.


• List the cardiopulmonary clinical manifestations associated with kyphoscoliosis.


• Describe the general management of kyphoscoliosis.


• Describe the clinical strategies and rationales of the SOAPs presented in the case study.


• Define key terms and complete self-assessment questions at the end of the chapter and on Evolve.



Key Terms





















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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.


Anatomic Alterations of the Lungs


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. Its appearance is most obvious in the anterior-posterior plane.


In severe kyphoscoliosis the deformity of the thorax compresses the lungs and restricts alveolar expansion, which in turn causes alveolar hypoventilation and atelectasis. In addition, the patient’s ability to cough and mobilize secretions also may be impaired, further causing atelectasis as secretions accumulate throughout the tracheobronchial tree. Because kyphoscoliosis involves both a posterior and a lateral curvature of the spine, the thoracic contents generally twist in such a way as to cause a mediastinal shift in the same direction as the lateral curvature of the spine. Severe kyphoscoliosis causes a chronic restrictive lung disorder that makes it more difficult to clear airway secretions. Figure 24-1 illustrates the lung and chest wall abnormalities in a typical case of kyphoscoliosis.


The major pathologic or structural changes of the lungs associated with kyphoscoliosis are as follows:




Etiology and Epidemiology


Kyphoscoliosis affects approximately 2% of the people in the United States—mostly young children who are going through a growing spurt. Kyphoscoliosis rarely develops in the adult—unless it is a worsening condition that started in childhood and was not diagnosed or treated. Kyphoscoliosis may also develop in adults from a degenerative joint condition in the spine. Although the precise cause of kyphoscoliosis is unknown, it is commonly associated with the following general conditions:



Other possible causes include hormonal imbalance, trauma, extraspinal contractures, infections involving the vertebrae, metabolic bone disorders (e.g., rickets, osteoporosis, osteogenesis imperfecta), joint disease, and tumors.


Depending on the child’s age at the time of onset, idiopathic scoliosis is classified as infantile, juvenile, or adolescent. In infantile scoliosis the curvature of the spine develops during the first 3 years of life. In juvenile scoliosis the curvature occurs at 4 years of age to the onset of adolescence. In adolescent scoliosis the spinal curvature develops after the age of 10. Adolescent scoliosis is the most common. Early signs (i.e., appearing when a child is approximately 8 years of age) of scoliosis include uneven shoulder height, prominent shoulder blade(s), uneven waist height, elevated hips, and leaning to one side. Risk factors include the following:




Diagnosis


Scoliosis is diagnosed by means of the patient’s medical history, physical examination, x-ray evaluation, and curve measurement. Clinically, scoliosis is commonly defined according to the following factors related to the curvature of the spine:



• Shape (nonstructural scoliosis and structural scoliosis)—A nonstructural scoliosis is a curve that develops side-to-side as a C– or S-shaped curve. This form of scoliosis results from a cause other than the spine itself (e.g., poor posture, leg length discrepancy, pain). A structural scoliosis is a curvature of the spine associated with vertebral rotation. A structural scoliosis involves the twisting of the spine and appears in three dimensions.


• Location—The curve of the spine may develop in the upper back area where the ribs are located (thoracic), the lower back area (lumbar), or in both areas (thoracolumbar).


• Direction—Scoliosis can bend the spine left or right.


• Angle—A normal spine viewed from the back is zero degrees—a straight line. Scoliosis is defined as a spinal curvature of greater than 10 degrees (i.e., bending toward the ground when in the upright position). The degree of the lateral curvature is expressed by the Cobb angle, which is calculated from a radiograph as shown in Figure 24-2.


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FIGURE 24-2 A, Chest x-ray on patient with kyphoscoliosis. B, Method of calculating the Cobb angle. Scoliosis is defined as a spinal curvature of 10 degrees or greater. Because the Cobb angle reflects curvature only in a single plane, it may fail to fully identify the severity of the scoliosis—especially when the patient has vertebral rotation and three-dimensional spinal deformity.


image OVERVIEW of the Cardiopulmonary Clinical Manifestations Associated with Kyphoscoliosis


The following clinical manifestations result from the pathophysiologic mechanisms caused (or activated) by Atelectasis (see Figure 9-8) and Excessive Airway Secretions (see Figure 9-12)—the major anatomic alterations of the lungs associated with kyphoscoliosis (see Figure 24-1).



CLINICAL DATA OBTAINED AT THE PATIENT’S BEDSIDE



The Physical Examination









CLINICAL DATA OBTAINED FROM LABORATORY TESTS AND SPECIAL PROCEDURES



Pulmonary Function Test Findings Moderate to Severe Kyphoscoliosis (Restrictive Lung Pathology)





Arterial Blood Gases




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Jun 11, 2016 | Posted by in RESPIRATORY | Comments Off on Kyphoscoliosis

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