Neuromuscular Scoliosis Workup

Updated: Feb 14, 2019
  • Author: Matthew B Dobbs, MD; Chief Editor: Jeffrey A Goldstein, MD  more...
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Workup

Laboratory Studies

Laboratory tests that may be helpful include the following:

  • Total lymphocyte count (should be >1500/μL) - Total lymphocyte count is one means of assessing nutritional status, which is extremely important because as many as 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 higher 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 (BUN) - 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
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Radiography

Supine anteroposterior (AP) and lateral spinal radiographs are ordered for very young patients and older patients who cannot sit. 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, an AP spinal radiograph, and a lateral spinal radiograph.

Neuromuscular scoliosis. Preoperative clinical pic Neuromuscular scoliosis. Preoperative clinical picture of a young male with severe scoliosis secondary to quadriplegic cerebral palsy.
Neuromuscular scoliosis. Preoperative anteroposter Neuromuscular scoliosis. Preoperative anteroposterior spinal radiograph of young male with severe scoliosis secondary to quadriplegic cerebral palsy.
Neuromuscular scoliosis. Preoperative lateral spin Neuromuscular scoliosis. Preoperative lateral spinal radiograph of young male with severe scoliosis secondary to quadriplegic cerebral palsy.

Traction spinal 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.

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Other Tests

Patients capable of cooperating should be evaluated preoperatively with pulmonary function studies (see Surgical Therapy).

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