tailieunhanh - Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 69

Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 69. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | Neuromuscular Scoliosis Chapter 24 673 Neurological Examination The treating surgeon must complete a thorough physical examination not limited to the musculoskeletal examination. Literally a head to toe examination is required to search for NMD. Missing abdominal reflexes can be a subtle sign of neurogenic scoliosis. Flaccid faces can be suggestive of subtle myopathies while asymmetrical shoe size can be a subtle sign of syringomyelia. Having the patient walk and run while looking for gait pattern and upper extremity posturing can elucidate a subtle spastic diplegia. Lower extremity morphological asymmetry such as a unilateral cavus must alert the surgeon that there may be underlying spinal cord pathology warranting further investigation. A detailed neurological examination must be carried out to assess for both sensory and motor deficits. Testing reflexes and looking for long tract signs such as Babinski s and Hoffman s signs clonus and spasticity are all part of a first visit examination of a newly diagnosed scoliosis. If weakness is present differentiating proximal from distal distribution may help in differentiating neuropathies from myopathies. Looking for proximal girdle strength should also be tested by asking the child to stand unassisted from a sitting position. If the child is unable to do so or uses their hands to push themselves up by adapting a wide base gait and locks the knees in extension with the hands and uses the hands to push themselves along on their legs then this is considered a positive Gower test. Romberg s test should also be performed to test cerebellar function testing balance with eyes closed feet side by side and arm forward flexed . Signs of calf hypotrophy are also documented as a diagnosis of Charcot-Marie-Tooth disease can be made. Always check abdominal reflexes Diagnostic Work-up Medical Assessment Confirming the diagnosis of neuromuscular scoliosis is best done in a multidisciplinary fashion by including the neurologist and .