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littleone
06-21-2010, 04:35 AM
Last x-ray performed around 2 months ago, was measured to be 34 degrees.
Chiropractor said that we should go off by 4 degrees, so it would be 30. She said that maybe I was stress, tense, and it made it look worse.

Could someone tell me which measurement is the right one, or how it is usually correct?

Pooka1
06-21-2010, 07:18 AM
Last x-ray performed around 2 months ago, was measured to be 34 degrees.
Chiropractor said that we should go off by 4 degrees, so it would be 30. She said that maybe I was stress, tense, and it made it look worse.

Could someone tell me which measurement is the right one, or how it is usually correct?

Those are the same measurement within the +/- 5* precision. The fact that the chiro thought those measurements were different and that it might be due to stress or tension shows that she doesn't have even basic training in reading Cobb angles. Readings at the beginning and end of the day, however, might affect the reading.

You should make sure an experienced orthopedic surgeon specializing in spine is determining your Cobb angle. They are the only ones with the proper training to advise you.

coscottsx61
06-21-2010, 08:09 AM
Totally agree with Pooka1. Through the last 35 years of my scoliosis journey I have seen many chiros and mds that knew nothing about the correct measurment proceudres. Check out a good spinal specialist. It is well worth your time. Good luck and prayers.

skevimc
06-21-2010, 12:49 PM
Last x-ray performed around 2 months ago, was measured to be 34 degrees.
Chiropractor said that we should go off by 4 degrees, so it would be 30. She said that maybe I was stress, tense, and it made it look worse.

Could someone tell me which measurement is the right one, or how it is usually correct?

I'll add to what has already been said (with which I totally agree). It bothers me a bit that the chiro said it would be 4 off and so it would be 30. The measurement error is 5. That means on the one x-ray. So if your x-ray read 34 it could be 29-39. If your x-ray from 2 months ago was 30 I wouldn't really think it would be 39 now... but this is a good example of why having a specialist look at it. You could even ask the chiro for copies of your x-rays and take them to a spine doctor. Find a scoliosis research society (SRS) certified doctor in your area. It would be well worth the effort.

I'm also not sure why you were given an x-ray 2 months after the other one. That's a bit quick. 4 months is the standard interval.

Good luck and keep posting here if you have other questions.

Chris43
07-05-2010, 08:02 PM
Hi! This is the first time I've tried this. I'm so glad I was told about this place. I really need to talk to other parents about their experiences with this awful disease. Your title fascinated me because I also have a question about the measurement of the curves, as well as many other questions. I guess I'll just fire away and hope someone can answer some of these!
#1 Can an x-ray be wrong because fo the way a child is standind during the x-ray? I have one orthopedic doctor telling me my daughter has an S curve of 31 and 33 and she needs the brace. I have another orthopedic doctor who took his own x-ray saying that she has an S curve 41 and 48 and needs surgery. HUGE difference! I noticed a difference in the way she was standing for each x-ray-one she was quite straight with her head up bacause the technician adjusted her-the other the technician never touched her, just told her to stand straight.
#2 Is there anyone out there who has had a curve in the 40's and opted NOT to have surgery? What has your quality of life been like?
#3 How do you choose that surgery when your child isn't complaining, has no back pain, and looks OK?
#4 Has anyone tried the Schroth method? Did it work? It's very expensive and not covered by insurance, but if it will prevent surgery, I'm all for it!
#5 I was told by the physical therapist Pilates, Yoga, Dance, and Swimming were the best things for my daughter to do during her two whole hours out of her Boston brace. Then I had a Schroth Chiropracter tell me NOT to do Pilates or Yoga because it could make her curve worse. Does anyone know about these activities? Harmful or helpful? I'm trying to figure out what's best for my daughter, as I'm sure you have all done as well.
I'm so confused about the whole thing and the more I read the worse it seems to get. If anyone could get back to me I would really appreciate it! Thanks!

Chris43
07-05-2010, 08:07 PM
Hi! This is the first time I've tried this. I'm so glad I was told about this place. I really need to talk to other parents about their experiences with this awful disease. Your title fascinated me because I also have a question about the measurement of the curves, as well as many other questions. I guess I'll just fire away and hope someone can answer some of these!
#1 Can an x-ray be wrong because fo the way a child is standind during the x-ray? I have one orthopedic doctor telling me my daughter has an S curve of 31 and 33 and she needs the brace. I have another orthopedic doctor who took his own x-ray saying that she has an S curve 41 and 48 and needs surgery. HUGE difference! I noticed a difference in the way she was standing for each x-ray-one she was quite straight with her head up bacause the technician adjusted her-the other the technician never touched her, just told her to stand straight.
#2 Is there anyone out there who has had a curve in the 40's and opted NOT to have surgery? What has your quality of life been like?
#3 How do you choose that surgery when your child isn't complaining, has no back pain, and looks OK?
#4 Has anyone tried the Schroth method? Did it work? It's very expensive and not covered by insurance, but if it will prevent surgery, I'm all for it!
#5 I was told by the physical therapist Pilates, Yoga, Dance, and Swimming were the best things for my daughter to do during her two whole hours out of her Boston brace. Then I had a Schroth Chiropracter tell me NOT to do Pilates or Yoga because it could make her curve worse. Does anyone know about these activities? Harmful or helpful? I'm trying to figure out what's best for my daughter, as I'm sure you have all done as well.
I'm so confused about the whole thing and the more I read the worse it seems to get. If anyone could get back to me I would really appreciate it! Thanks!

Pooka1
07-05-2010, 08:35 PM
Hi. Very sorry about the diagnosis. I'll answer if I can and hope that others chime in also. It is important to understand the range of experience when asking for comment.



#1 Can an x-ray be wrong because of the way a child is standing during the x-ray? I have one orthopedic doctor telling me my daughter has an S curve of 31 and 33 and she needs the brace. I have another orthopedic doctor who took his own x-ray saying that she has an S curve 41 and 48 and needs surgery. HUGE difference! I noticed a difference in the way she was standing for each x-ray-one she was quite straight with her head up because the technician adjusted her-the other the technician never touched her, just told her to stand straight.

When you say "orthopedic doctor" do you mean a board certified pediatric orthopedic surgeon or something else? Also, how close in time were those radiographs taken? That seems like too big a difference even if she wasn't standing straight and perpendicular to the beam for the lower measurements. If anything, I think the higher measurements are more likely to be correct (if measured by an orthopedic surgeon) because not standing perpendicular to the beam would only decrease the apparent measurement as I understand the geometry here (which I may not).


#2 Is there anyone out there who has had a curve in the 40's and opted NOT to have surgery? What has your quality of life been like?

I think unless progression is shown, few surgeons would operate on those curves. Just my opinion. How fast has the progression, if any, been? I have lately been questioning waiting until the curves are larger if it means more levels fused. It's possible your surgeon might be of the opinion that he can fuse less levels if he operates on smaller curves.


#3 How do you choose that surgery when your child isn't complaining, has no back pain, and looks OK?

There is a huge risk of needing surgery later in life when it is far less tolerable and may involve many more levels plus ancillary damage from having curves over the years.


#4 Has anyone tried the Schroth method? Did it work? It's very expensive and not covered by insurance, but if it will prevent surgery, I'm all for it!

I am not aware of any evidence it has prevented a single surgery due to progression. It may have delayed surgery due to pain. No conservative treatment has shown any evidence of permanently halting progression or reducing a curve. If it did then there would be no need for surgery, a result we don't obtain as people are still needing to be fused even after trying several conservative modalities.


#5 I was told by the physical therapist Pilates, Yoga, Dance, and Swimming were the best things for my daughter to do during her two whole hours out of her Boston brace. Then I had a Schroth Chiropracter tell me NOT to do Pilates or Yoga because it could make her curve worse. Does anyone know about these activities? Harmful or helpful? I'm trying to figure out what's best for my daughter, as I'm sure you have all done as well.

The fact that different PT purveyors disagree on what is good and bad and claim mutually exclusive things over decades and decades is pretty good proof NONE of them have any evidence whatsoever for any of their claims.


I'm so confused about the whole thing and the more I read the worse it seems to get. If anyone could get back to me I would really appreciate it! Thanks!

It's very confusing. There is no good answer. Each case is different. Surgeons differ even on the question of surgery not to mention which levels to fuse. The best you can do is get as many opinions from board-certified pediatric orthopedic surgeons specializing in scoliosis as you can. At some point, the opinions will converge and you know you have made the best decision possible in your case. Nobody else besides surgeons is qualified to advise you.

How old is your daughter?

Good luck.

Chris43
07-05-2010, 10:00 PM
Thanks for responding so quickly! To answer your questions...my daughter is 14 and at a Risser of 1(no period yet). The x-rays were taken three weeks apart. Yes, I was talking about a board certified pediatric orthopedic surgeon. He feels that she will certainly progress beyond the 41 and 48.He didn't give us much hope. The first orthopedic doctor was from my local office. He was the one that said she was a 31 and 33. I really want to believe him. I guess you were a good reality check for me. I was hoping to hear from someone who would say that Schroth program is the best and pilates and yoga will do it! It's just all so new to me. I'm really not sure who or what to believe. I'm glad you said that sooner or later most of the doctors will agree, somewhat ,on the treatment for her. I am having a second opinion at another major hospital in my area at he end of the month. I hope that will help us out a little.Thanks again for responding!
Chris

Pooka1
07-06-2010, 05:55 AM
On the radiograph geometry, if you bend a pipe cleaner and then rotate it, I think you will see that the maximal angle would be when the curve is viewed straight on. At the other extreme, if you look at the curve from the side, it will appear to be perfectly straight. So I think your daughter must have been at some angle to the beam for the lower numbers which is outrageous when we are talking radiation and needing a better set of films within a few weeks. I really think that is extremely incompetent of them.

If she is at 41/48 and a Risser 1, from what is known of progression, she will most likely progress. There are oddball cases, 2-3 on this group even, where someone made it to lower 50* as an adolescent and hung there for even two decades. One of these people had the surgery anyway for pain despite lack of progression. But those serve to show mainly the huge variability of this condition and not a reasonable hope in any one case.

Both my daughters required fusion. One of them had a very fast moving curve such that we scheduled the surgery when she was in the 40s and 2 months later she was 58* on the table. Her curve was never documented to move less than 5* a month. It sounds like your surgeon thinks your daughter's curve will move quickly if she is going into the growth spurt as her Risser might suggest. Earlier surgery in this case may mean less levels fused which is important in your daughter's case because she has a double major curve. If you can spare some lumbar vertebrae by operating earlier then that would be very good. You may want to ask specifically about this. Ask which levels would be fused now versus if the curve progressed. I have questions about if earlier fusion would have required less levels fused with both my daughters. They each have 10 levels fused.

Schroth was developed in Germany and has been around at least 90 years. Their publication record is minimal and there is no evidence they avoided a single surgery by halting progression or reducing a curve. It is interesting to note that Schroth is still a fringe treatment in Germany per what I have read. You would think if it was effective at letting people avoid surgery that it would be the most popular treatment. And yet it is fringe. I submitted Schroth's pub list to Quackwatch and they agreed it is unproven. After ~90 years. I have a thread on this called "Schroth and Quackwatch" or something close to that. By the way, Schroth advocates bracing though the growth spurt as far as I know so even they admit PT alone will not hold a curve at that point.

The efficacy of bracing is in question also, after decades of use. The situation with bracing is uncanny in that it is the standard of care despite having no good evidence it works. Many surgeons are open about their doubts about bracing. The BRAiST study is trying to gather evidence one way or the other.

Together, PT and bracing are conservative treatments that have a foothold in science. Other things like chiro (Clear), rain drop therapy, TAMARS, etc. are alternative and don't have a lick of evidence in keeping with their non-scientific premises. They have no evidence of efficacy whatsoever and likely will never have any.

Good luck.

LindaRacine
07-06-2010, 03:57 PM
Chris...

It's entirely possible that there has not been any progression. With the exception of doctors who specialize in scoliosis (and even some of them), the methods used to measure films are all over the place. I wouldn't obsess about it at this point. If you can, find an orthopaedist who specializes in scoliosis, and let him/her read the films. You can find a list of them here:

http://www.srs.org/find/

Regards,
Linda