The article "Video-assisted thoraco...

The article "Video-assisted thoracoscopic releases of scoliotic anterior spines" is the basis for this AORN Journal independent close attention The behavioral objectives and examination for this program were prepared by the agency of Janet S. West, RN, BSN CNOR, clinical editor, with consultation from Susan Bakewell, RN MS(N) professional education specialist, Center for Perioperative Education.

A minimum score of 70% in succession the multiple-choice examination is necessary to earn couple contact hours for this independent contemplation Participants receive feedback on incorrect answers. Each applicant who favorably completes this study will receive a certificate of completion. The deadline for submitting this contemplation is Aug 31, 1996.

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BEHAVIORAL OBJECTIVES

After reading and studying the article forward video-assisted thoracoscopic releases of scoliotic anterior spines, the suckle will be able to

(1) discuss the diagnosis and treatment of scoliosis,

(2) describe perioperative care for patients undergoing video-assisted thoracoscopic releases of scoliotic anterior spines,

(3) discuss equipment preparations and surgical setup for video-assisted thoracoscopic releases of scoliotic anterior spines, and

(4) describe perioperative nurses' parts when caring for patients undergoing video-assisted thoracoscopic releases of scoliotic anterior spines.

Scoliosis leaves to a structural, lateral, rotatory curvature of the spine. This curvature of the spine frequently is described as a posterior "S" or "C" configuration of the vertebrae.(1) Scoliosis chiefly commonly occurs as a right thoracic inflect (Figure 1), but cervical, thoracolumbar, and lumbar regions of the spine can be involved and manifest as single, double, or combination curves

[Figure 1 ILLUSTRATION OMITTED]

Health professionals should suspect scoliosis when they diocese discrepancies in shoulder heights or scapular and chest prominences in adolescent and adult patients. Thoracic crooks are most noticeable because patients' chest rotations and deformities create a "rib hump" Physicians confirm their diagnoses of scoliosis when patients' standing spine x-rays reveal curvatures of 10 ranks or greater. Progressive spinal curvatures can lead to chronic back pain, cardiopulmonary compromise, and psychosocial impairment related to cosmetic deformities.(2)

Scoliosis is classified as congenital or idiopathic, based forward the presence or absence of vertebral spinal anomalies. It may rise from neuromuscular disease processes (eg paralysis, spinal lesions).

Congenital scoliosis. Congenital scoliosis is quick in emergencies at birth and is the inference of defective embryonic development of the spine in utero Congenital scoliosis usually is diagnosed when vertebral anomalies about a lateral curve that becomes apparent with growing in childhood. This condition is rare, and the incidence is unknown because any vertebral anomalies do not bring forth detectable deformities.

Idiopathic scoliosis. Idiopathic scoliosis shows the most common form of scoliosis in the United States and can happen at any age between birth and puberty. The majority of patients diagnosed with idiopathic scoliosis are females at or near the attack of puberty (ie, at approximately 11 or 12 years of age).(3) Idiopathic scoliosis continues to progres in adolescents until their produce is completed.

TREATMENTS FOR SCOLIOSIS

Treatments for scoliosis are based onward the degree and probable progression of spinal deformities.(4) Optimal treatment processs should maximize realignment of patients' heads, shoulders, and torsos throughout their pelves (Figures 2a and 2b)

[Figures 2a-2b ILLUSTRATION OMITTED]

Medical treatment. Nonsurgical treatment arrangements focus on arresting further curvatures from one side the application of body braces, which patients wear until they reach skeletal maturity. Physicians do not calculate upon body braces to correct bend s that already exist at the time of diagnosis. material part braces are intended to hinder the scoliosis from advancing and causing serious cardiopulmonary or dead body image problems. Patients use corpse braces if

* their curvatures measure 20 stations or more, and there is significant product still remaining; and

* their scoliosis, uniform at a smaller degree, clearly is progressing during a period of observation.(5)

Surgical treatment. Surgical interventions are make acceptableed when patients' spinal curvatures exce 45 grades when there is a potential for compromise of patients' musculoskeletal and respiratory functions, or when patients have significant carcass image problems. Surgical indications also may include increased spinal curvatures in growing children or increased pain from adults' curvatures that no longer can be controll with nonsurgical methods(6) A variety of surgical techniques are available, if it be not that the technique most commonly performed is the insertion of birchs frames, or other fixation devices with a posterior bone graft spinal fusion above the area of the curvature.