- Author: R Carter Cassidy, MD; Chief Editor: Jason H Calhoun, MD, FACS more...
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Standard laboratory results should be evaluated whenever surgical intervention is being considered. The laboratory workup should include determination of a complete blood count, coagulation studies, and routine chemical analyses.
Autodonation of blood can be recommended to the patient in anticipation of the need for intraoperative transfusion.
In patients with a known or suspected infectious etiology, the sedimentation rate and C-reactive protein level should be measured to help identify a potential infection or to help track the progress of treatment.
Before a major operation, the patient's nutritional status might also be checked, because it considerably influences a patient's ability to heal.
Radiographs are crucial for both diagnosing kyphosis and for planning treatment.
The most useful radiographs are upright posteroanterior and lateral images of the entire spine. These views enable the reviewer to assess the sagittal balance of the entire spine and to determine if a scoliosis is present.
Measurements are made on radiographs by using the standard Cobb technique for scoliosis, which has been adapted to the measurement of kyphosis. Thoracic kyphosis is measured from T1-T12, though the upper thoracic vertebral endplates are often difficult to see. Normal measurements for thoracic spine vary widely, but the accepted definition of normal according to the Scoliosis Research Society is 20-40°. A plumb line dropped from C7 should pass through or just anterior to S1 on a lateral full-length image. This technique helps in assessing and quantifying the patient's overall sagittal alignment.
Radiographs obtained with the patient in a supine lateral hyperextension position over a bolster can be used to determine the flexibility of the curve. This information is useful in surgical planning. A flexible curve is best corrected with only posterior fusion, whereas an anterior only or combined anterior and posterior procedure may be needed for a stiff curve. A curve that corrects to 50° or less on hyperextension can be treated with posterior-only fusion.[17, 18] Postural kyphosis is rarely more than 60°, and it should correct to normal with hyperextension.
Magnetic resonance imaging
MRI can be a useful adjunct in planning treatment for patients with kyphosis. If a neurologic abnormality is present, MRI may aid in localizing impingement on neural structures.
If surgery is being planned for the treatment of postinfectious kyphosis, an MRI helps in planning an anterior approach with regard to the amount of resection needed (if any) to remove diseased bone.
Ensuring the adequacy of bone density is imperative when surgical correction of kyphosis is being considered. Correction of the kyphosis relies on instrumentation to reduce the spine, and considerable forces are placed on the instrumentation-bone interface. Osteopenic bone can predispose to loss of correction over time, if the instrumentation cuts through the relatively less dense vertebrae. If a patient's bone density is in question, bone densitometry can be perform to quantify it. Efforts should be made to a patient's improve bone density before and following surgery. When bone density is poor, the surgeon must usually increase the number of points of fixation to reduce the stress at each point.
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