Laboratory Studies

Laboratory tests that may be helpful in the workup of neuromuscular scoliosis 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

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 picture of a young male with severe scoliosis secondary to quadriplegic cerebral palsy.

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Neuromuscular scoliosis. Preoperative anteroposterior spinal radiograph of young male with severe scoliosis secondary to quadriplegic cerebral palsy.

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Neuromuscular scoliosis. Preoperative lateral spinal radiograph of young male with severe scoliosis secondary to quadriplegic cerebral palsy.

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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.

Other Tests

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

Treatment & Management

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Media Gallery

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.

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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.

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, AOSpine, Cervical Spine Research Society, International Society for the Advancement of Spine Surgery, International Society for the Study of the Lumbar Spine, Lumbar Spine Research Society, North American Spine Society, Scoliosis Research Society, Society of Lateral Access Surgery

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Globus, 3Spine<br/>Received income in an amount equal to or greater than $250 from: Globus, Nuvasive, Surgalign, 3Spine.

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.

William O Shaffer, MD Former 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, International Society for the Study of the Lumbar Spine, Kentucky Medical Association, Kentucky Orthopaedic Society, North American Spine Society, Southern Medical Association, Southern Orthopaedic Association

Disclosure: Nothing to disclose.

Neuromuscular Scoliosis Workup

Laboratory Studies

Radiography

Other Tests

References

Tables

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