Neuromuscular Scoliosis Workup
- Author: Matthew B Dobbs, MD; Chief Editor: Jeffrey A Goldstein, MD more...
See the list below:
- Total lymphocyte count
- The total lymphocyte count should be greater than 1500 cells/mm3.
- Total lymphocyte count is one means of assessing nutritional status, which is extremely important since up to one third of patients with neuromuscular conditions are malnourished. Detecting and correcting malnutrition preoperatively helps prevent postoperative wound infection and healing problems.
- Hemoglobin: Assessing hemoglobin helps to determine nutritional status and whether a blood transfusion is likely to be needed.
- Total protein: Total protein is assessed to determine nutritional status.
- Albumin: Patients with serum albumin levels greater than 3.5 mg/dL have a much lower incidence of postoperative wound infection.
- Electrolytes: Electrolytes are assessed in the evaluation of nutritional status.
- Serum blood urea nitrogen: This test is also useful in the assessment of nutritional status.
- Creatinine: Creatinine levels are used to assess nutritional status.
- Transferrin: An index using transferrin and albumin levels to identify malnourished patients has been developed.
See the list below:
- Supine anteroposterior and lateral spinal radiographs: These are ordered for very young patients and older patients who cannot sit.
- Upright anteroposterior and lateral spinal radiographs
- Standing upright radiographs should be used for patients who can stand, and sitting radiographs should be used for patients who cannot stand.
- For the radiographs, standing patients do not support themselves with crutches, and sitting patients use no hand support. This gives an accurate depiction of the true magnitude of the spinal deformity under the effect of gravity and of pelvic obliquity and spinal balance.
- The images below show a single patient in a photograph, anteroposterior spinal radiograph, and lateral spinal radiograph.Neuromuscular scoliosis. Preoperative clinical picture of a young male with severe scoliosis secondary to quadriplegic cerebral palsy.Neuromuscular scoliosis. Preoperative anteroposterior spinal radiograph of young male with severe scoliosis secondary to quadriplegic cerebral palsy.
- Traction spinal radiographs: These radiographs are obtained to evaluate the flexibility of the curves. These can be obtained in the radiology department with manual distraction with head halter and leg traction.
See the list below:
- Patients capable of cooperating should be evaluated preoperatively with pulmonary function studies (see Preoperative details).
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