What are important points to assess on physical examination in the patient being evaluated for possible revision spine surgery

A general neurologic assessment and regional spinal assessment are performed. The presence of nonorganic signs (Waddell signs) should be assessed. Global spinal balance in the sagittal and coronal planes should be assessed. The physical examination is tailored to the particular spinal pathology under evaluation. For cervical spine disorders, shoulder pathology, brachial plexus disorders, and conditions involving the peripheral nerves should not be overlooked. For lumbar spine problems, the hip joints, sacroiliac joints, and prior bone graft sites should be assessed. Examination of peripheral pulses is routinely performed to rule out vascular insufficiency. Consider degenerative neurologic or muscle-based problems, such as amyotrophic lateral sclerosis or multiple sclerosis.

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