Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Neuromuscular Scoliosis Workup

  • Author: Matthew B Dobbs, MD; Chief Editor: Jeffrey A Goldstein, MD  more...
 
Updated: Dec 16, 2014
 

Laboratory Studies

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.
Next

Imaging Studies

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 picNeuromuscular scoliosis. Preoperative clinical picture of a young male with severe scoliosis secondary to quadriplegic cerebral palsy.
      Neuromuscular scoliosis. Preoperative anteroposterNeuromuscular scoliosis. Preoperative anteroposterior spinal radiograph of young male with severe scoliosis secondary to quadriplegic cerebral palsy.
      Neuromuscular scoliosis. Preoperative lateral spinNeuromuscular scoliosis. Preoperative lateral 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.
Previous
Next

Other Tests

See the list below:

  • Patients capable of cooperating should be evaluated preoperatively with pulmonary function studies (see Preoperative details).
Previous
 
 
Contributor Information and Disclosures
Author

Matthew B Dobbs, MD Associate Professor, Department of Orthopaedic Surgery, Washington University School of Medicine

Matthew B Dobbs, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Lawrence G Lenke, MD Jerome J Gilden Professor of Orthopedic Surgery, Section of Spinal Surgery, Director of Residency Program, Washington University School of Medicine; Chief of Spinal Surgery, Department of Orthopedic Surgery, St Louis Shriners Hospital

Lawrence G Lenke, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Scoliosis Research Society, American Medical Association, American Orthopaedic Association, American Spinal Injury Association, Missouri State Medical Association, North American Spine Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

William O Shaffer, MD Orthopedic Spine Surgeon, Northwest Iowa Bone, Joint, and Sports Surgeons

William O Shaffer, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Kentucky Medical Association, North American Spine Society, Kentucky Orthopaedic Society, International Society for the Study of the Lumbar Spine, Southern Medical Association, Southern Orthopaedic Association

Disclosure: Received royalty from DePuySpine 1997-2007 (not presently) for consulting; Received grant/research funds from DePuySpine 2002-2007 (closed) for sacropelvic instrumentation biomechanical study; Received grant/research funds from DePuyBiologics 2005-2008 (closed) for healos study just closed; Received consulting fee from DePuySpine 2009 for design of offset modification of expedium.

Chief Editor

Jeffrey A Goldstein, MD Clinical Professor of Orthopedic Surgery, New York University School of Medicine; Director of Spine Service, Director of Spine Fellowship, Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, NYU Langone Medical Center

Jeffrey A Goldstein, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Orthopaedic Association, North American Spine Society, Scoliosis Research Society, Cervical Spine Research Society, International Society for the Study of the Lumbar Spine, AOSpine, Society of Lateral Access Surgery, International Society for the Advancement of Spine Surgery, Lumbar Spine Research Society

Disclosure: Received consulting fee from Medtronic for consulting; Received consulting fee from NuVasive for consulting; Received royalty from Nuvasive for consulting; Received consulting fee from K2M for consulting; Received ownership interest from NuVasive for none.

Additional Contributors

Lee H Riley III, MD Chief, Division of Orthopedic Spine Surgery, Associate Professor, Departments of Orthopedic Surgery and Neurosurgery, Johns Hopkins University School of Medicine

Disclosure: Nothing to disclose.

References
  1. Benites BD, Traina F, Duarte AD, Lorand-Metze IG, Costa FF, Saad ST. Increased expression of APAF-1 in low-risk myelodysplastic syndrome: a possible role in the pathophysiology of myelodysplasia. Eur J Haematol. 2010 Mar 23. [Medline].

  2. Dane B, Dane C, Aksoy F, Cetin A, Yayla M. Arthrogryposis multiplex congenita: analysis of twelve cases. Clin Exp Obstet Gynecol. 2009. 36(4):259-62. [Medline].

  3. Sarwark J, Sarwahi V. New strategies and decision making in the management of neuromuscular scoliosis. Orthop Clin North Am. 2007 Oct. 38(4):485-96, v. [Medline].

  4. Barsdorf AI, Sproule DM, Kaufmann P. Scoliosis surgery in children with neuromuscular disease: findings from the US National Inpatient Sample, 1997 to 2003. Arch Neurol. 2010 Feb. 67(2):231-5. [Medline].

  5. Bridwell KH, O''Brien MF, Lenke LG, et al. Posterior spinal fusion supplemented with only allograft bone in paralytic scoliosis. Does it work?. Spine. 1994 Dec 1. 19(23):2658-66. [Medline].

  6. Brook PD, Kennedy JD, Stern LM, et al. Spinal fusion in Duchenne''s muscular dystrophy. J Pediatr Orthop. 1996 May-Jun. 16(3):324-31. [Medline].

  7. Gersoff WK, Renshaw TS. The treatment of scoliosis in cerebral palsy by posterior spinal fusion with Luque-rod segmental instrumentation. J Bone Joint Surg Am. 1988 Jan. 70(1):41-4. [Medline].

  8. Sussman MD, Little D, Alley RM, McCoig JA. Posterior instrumentation and fusion of the thoracolumbar spine for treatment of neuromuscular scoliosis. J Pediatr Orthop. 1996 May-Jun. 16(3):304-13. [Medline].

  9. Mercado E, Alman B, Wright JG. Does spinal fusion influence quality of life in neuromuscular scoliosis?. Spine. 2007 Sep 1. 32(19 Suppl):S120-5. [Medline].

  10. Gregg FO, Zhou H, Bertrand SL. Treatment of neuromuscular scoliosis with posterior spinal fusion using the galveston procedure: retrospective of eight years of experience with unit rod instrumentation. J Long Term Eff Med Implants. 2012. 22(1):11-5. [Medline].

  11. Rinsky LA. Surgery of spinal deformity in cerebral palsy. Twelve years in the evolution of scoliosis management. Clin Orthop. 1990 Apr. (253):100-9. [Medline].

  12. Sarwahi V, Sarwark JF, Schafer MF, et al. Standards in anterior spine surgery in pediatric patients with neuromuscular scoliosis. J Pediatr Orthop. 2001 Nov-Dec. 21(6):756-60. [Medline].

  13. Westerlund LE, Gill SS, Jarosz TS, et al. Posterior-only unit rod instrumentation and fusion for neuromuscular scoliosis. Spine. 2001 Sep 15. 26(18):1984-9. [Medline].

  14. Phillips JH, Gutheil JP, Knapp DR Jr. Iliac screw fixation in neuromuscular scoliosis. Spine. 2007 Jun 15. 32(14):1566-70. [Medline].

  15. Modi H, Suh SW, Song HR, Yang JH. Accuracy of thoracic pedicle screw placement in scoliosis using the ideal pedicle entry point during the freehand technique. Int Orthop. 2008 Mar 21. [Medline].

  16. Viswanathan A, Johnson KK, Whitehead WE, Curry DJ, Luerssen TG, Jea A. Hybrid spinal constructs using sublaminar polyester bands in posterior instrumented fusions in children: a series of 5 cases. Neurosurgery. 2010 May. 66(5):862-7; discussion 867. [Medline].

  17. Keeler KA, Lenke LG, Good CR, Bridwell KH, Sides B, Luhmann SJ. Spinal Fusion for Spastic Neuromuscular Scoliosis: Is Anterior Releasing Necessary When Intraoperative Halo-Femoral Traction Is Used?. Spine (Phila Pa 1976). 2010 Apr 13. [Medline].

  18. Akbarnia BA, Cheung K, Noordeen H, Elsebaie H, Yazici M, Dannawi Z, et al. Next Generation of Growth-Sparing Technique: Preliminary Clinical Results of a Magnetically Controlled Growing Rod (MCGR) in 14 Patients With Early Onset Scoliosis. Spine (Phila Pa 1976). 2012 Oct 10. [Medline].

  19. Albert MC, LaFleur BC. Hybrid Fixation With Sublaminar Polyester Bands in the Treatment of Neuromuscular Scoliosis: A Comparative Analysis. J Pediatr Orthop. 2014 Jul 17. [Medline].

  20. Pruijs JE, van Tol MJ, van Kesteren RG, van Nieuwenhuizen O. Neuromuscular scoliosis: clinical evaluation pre- and postoperative. J Pediatr Orthop B. 2000 Oct. 9(4):217-20. [Medline].

  21. Rawlins BA, Winter RB, Lonstein JE, et al. Reconstructive spine surgery in pediatric patients with major loss in vital capacity. J Pediatr Orthop. 1996 May-Jun. 16(3):284-92. [Medline].

  22. Cheuk DK, Wong V, Wraige E, Baxter P, Cole A, N'Diaye T, et al. Surgery for scoliosis in Duchenne muscular dystrophy. Cochrane Database Syst Rev. 2007 Jan 24. CD005375. [Medline].

  23. Mohamad F, Parent S, Pawelek J, Marks M, Bastrom T, Faro F, et al. Perioperative complications after surgical correction in neuromuscular scoliosis. J Pediatr Orthop. 2007 Jun. 27(4):392-7. [Medline].

  24. Canavese F, Gupta S, Krajbich JI, Emara KM. Vacuum-assisted closure for deep infection after spinal instrumentation for scoliosis. J Bone Joint Surg Br. 2008 Mar. 90(3):377-81. [Medline].

  25. Hod-Feins R, Abu-Kishk I, Eshel G, Barr Y, Anekstein Y, Mirovsky Y. Risk factors affecting the immediate postoperative course in pediatric scoliosis surgery. Spine. 2007 Oct 1. 32(21):2355-60. [Medline].

  26. Myung KS, Lee C, Skaggs DL. Early Pelvic Fixation Failure in Neuromuscular Scoliosis. J Pediatr Orthop. 2014 Jul 2. [Medline].

  27. Awwad W, Al-Ahaideb A, Jiang L, Algarni AD, Ouellet J, Harold MU, et al. Correction of severe pelvic obliquity using maximum-width segmental sacropelvic screw fixation: an analysis of 20 neuromuscular scoliosis patients. Eur J Orthop Surg Traumatol. 2014 May 6. [Medline].

  28. Ferguson RL, Hansen MM, Nicholas DA, Allen BL Jr. Same-day versus staged anterior-posterior spinal surgery in a neuromuscular scoliosis population: the evaluation of medical complications. J Pediatr Orthop. 1996 May-Jun. 16(3):293-303. [Medline].

  29. Owen JH, Sponseller PD, Szymanski J, Hurdle M. Efficacy of multimodality spinal cord monitoring during surgery for neuromuscular scoliosis. Spine. 1995 Jul 1. 20(13):1480-8. [Medline].

  30. Huang MJ, Lenke LG. Scoliosis and severe pelvic obliquity in a patient with cerebral palsy: surgical treatment utilizing halo-femoral traction. Spine. 2001 Oct 1. 26(19):2168-70. [Medline].

Previous
Next
 
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.
Neuromuscular scoliosis. Preoperative lateral spinal radiograph of young male with severe scoliosis secondary to quadriplegic cerebral palsy.
Neuromuscular scoliosis. Postoperative clinical picture of young male with severe scoliosis secondary to quadriplegic cerebral palsy.
Neuromuscular scoliosis. Postoperative anteroposterior spinal radiograph of young male with severe scoliosis secondary to quadriplegic cerebral palsy at 2-year follow-up.
Neuromuscular scoliosis. Postoperative lateral spinal radiograph of young male with severe scoliosis secondary to quadriplegic cerebral palsy at 2-year follow-up.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.