Describe the key points to assess during examination of a patient with spinal deformity secondary to neuromuscular disease

• Assessment of level of function. Can the patient sit independently? Is the patient ambulatory?

• Assessment of general health status. Is there a history of seizures, frequent pneumonia, or poor nutrition?

Figure 7-4. A, Flatback syndrome. B, Normal sagittal plane alignment.
Figure 7-5. Neuromuscular scoliosis. A, Long sweeping curve with associated pelvic obliquity and loss of sitting balance. B, Assessment of curve flexibility.

Figure 7-6. Severe spondylolisthesis associated with sagittal plane decompensation.

• Evaluation of head control, trunk control, and motor strength. Does the underlying neuromuscular problem result in a spastic, flaccid, or athetoid picture?

• Assessment of curve flexibility. Curve flexibility can be assessed by grasping the head in the area of the mastoid process and lifting the patient from the sitting or standing position.

• Is pelvic obliquity present? Is it correctable with traction and positioning?

• Evaluation of the hip joints for coexistent pathology, including contractures.

• Is the patient's underlying neuromuscular disorder associated with any other organ system problems? For example, Duchenne muscular dystrophy is associated with cardiomyopathy.

• Documentation of pressure sores and areas of skin breakdown.

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