List important preoperative considerations in evaluation of patients with neuromuscular spinal deformity

• Functional status: Ambulatory function, sitting ability, hand function, mental ability, visual acuity

• Pulmonary assessment: Ask about history of upper respiratory infection or pneumonia; assess for chronic aspiration; perform pulmonary function testing if possible

• Gastrointestinal assessment: Assess for gastroesophageal reflux and intraabdominal volume compromise

• Cardiac assessment: Critical in disorders such as Duchenne's muscular dystrophy, Friedreich's ataxia, myotonic dystrophy due to associated cardiac anomalies

• Nutritional status: Address deficits to help prevent impaired wound healing and decrease infection risk

• Seizure disorders: Require assessment by a neurologist and confirmation of appropriate levels of antiseizure medications

• Metabolic bone disease: Osteopenia is common secondary to disuse, poor nutrition, and anticonvulsants. It is an important influence regarding strategy for spinal instrumentation

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