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pmc
01-24-2011, 11:19 AM
Hi everyone!

First time post, I just discovered this forum yesterday and am quite excited about the chance to speak with other curvy people! I'm a 38 yr old male, many signs were there when I was younger but they were never understood for what they were. In the last ten years I've felt that something was wrong with my back, but it was only last fall when it was given a name. My health insurance only exists because of low income, so I didn't get a lot of choices for specialists. I don't mean to badmouth the spine specialist I've seen, but he seemed rather detached and pressed for time. He pretty much brushed off my inquiry about what degrees the curves were and what classification of scoliosis it is. It might not be a big deal to him, but my life seems to rotate around my back these days so I would love a little information.

I would like to know what kind of curve it is because certain exercises (Yoga For Scoliosis, in particular) require us to know so we can properly adjust them to suit our needs. Would we just call this a right thoracic curve and a minor left lumbar- or is the lumbar curve enough to call it an "S" curve?

A rough sense of the degrees would be helpful so I can have some sense of how things are progressing (or not). Perhaps some of you would know from your own x-rays and might be able to give me a rough sense. I'd appreciate any help anyone can offer.

sincerely,

~Paul

hdugger
01-24-2011, 07:32 PM
I have to tell you up front that I'm really awful at reading xrays. I'm hoping someone who is better at it will chime in.

That's said, it looks like most of the curve is in the upper part of the spine, and the lower curve is a non-structural curve, so I'd call it thoracic. If you use the Lenke system (here - http://www.spinal-deformity-surgeon.com/images/curvatures.gif), it looks like a 2B to me)

Is the xray backwards? It looks like your curve is going to the left (which is unusual). If the xray is not backwards, then having a curve which goes the other way is probably going to change the classification.

The angle of the main curve on top looks subsurgical - maybe 30 something degrees?

pmc
01-24-2011, 09:33 PM
thanks for your reply! How can you tell from the x-ray what is structural and what is functional? The X-Ray is from the front (you can see an 'L" to denote the left side), though in my mind I tend to think of the curves from behind for some reason.

hdugger
01-24-2011, 10:07 PM
I can't actually tell :)

The general rule is that, if one curve looks substantially larger than the other, it's probable that it's structural and the other one is functional (and would disappear if you fused the other one). Sometimes that's really obvious - like my son has one curve that's in the 50s and the non-structural one is in the 20s - but sometimes it's not. I'm just guessing on yours.

Ah, sorry on the L stuff, for some reason I flipped myself around. Yeah, it's a right thoracic curve.

So, just for comparison on the numbers, here's my son's xray - http://www.flickr.com/photos/45701845@N05/4195964145/ - and it measures in the 50s. Yours looks like its a little more than half of that, but I could well be off.

pmc
01-25-2011, 08:22 AM
I didn't know that, but I can see how the lumbar could be more of a reaction or compensation for the other curve. And, that would conceivably halve my challenge!

Thanks for sharing the photo- it was helpful to have something to compare with and it's nice to have some sense of orientation/perspective. My best to your son, I can certainly sympathize!

Ballet Mom
01-25-2011, 04:40 PM
I agree with hdugger that the upper curve looks to be around 30 degrees, probably no more than 35. It looks very similar to my daughter's x-rays. There is a small compensatory lower curve that most doctors wouldn't even give you a cobb angle for. That means that it is simply compensating for the larger curve above and wouldn't be fused in any fusion surgery as it's not structural, i.e. it might disappear on its own once the upper structural curve was fused. Your upper curve looks subsurgical though, so you probably wouldn't be worried about that anyway.

Just below the letter L, it looks like there is the number 28? Could that possibly be the degrees of the curve listed there for you? I can't really read it, but it looks like there might be an angle symbol next to it. Sometimes they have the angle listed on the digital x-rays.

Please note that this is not professional medical advice, if you were really interested in the actual degrees, you could call your doctor's office and they could tell you the angle, it should be on your patient chart from the visit. In fact, you could just request a copy of the chart if you wanted.

pmc
01-25-2011, 04:58 PM
Ballet Mom,

Thanks for the reassuring words! Good thinking about the '28', I searched though the other x-rays (mostly views which mean little to me) and I found the '28' elsewhere including views which didn't show the upper curve. I'm not sure if that supports the idea or not.

I can't say I was overwhelmed with the doctor's involvement and interest level with my case- perhaps because he was a surgeon and felt I wasn't a candidate. I asked him about the degrees and he managed to weasel out of an answer. I don't know if others of you have experienced this, but some doctors seem to speak in vague disinterested riddles- almost another language. He said I should come back at some point to get new x-rays and see if anything has changed (meaning he gets to cut me open?) On the positive side, I guess it means that he doesn't see it as a severe enough case to worry about. Severe or not, this is a huge deal to me, and things like answers can be an enormous relief or at least point one in the right direction. This is why I've come to all of you, and it's brought me more information than I had before- thank you!!

Pooka1
01-25-2011, 05:49 PM
I can't say I was overwhelmed with the doctor's involvement and interest level with my case- perhaps because he was a surgeon and felt I wasn't a candidate. I asked him about the degrees and he managed to weasel out of an answer. I don't know if others of you have experienced this, but some doctors seem to speak in vague disinterested riddles- almost another language. He said I should come back at some point to get new x-rays and see if anything has changed (meaning he gets to cut me open?) On the positive side, I guess it means that he doesn't see it as a severe enough case to worry about. Severe or not, this is a huge deal to me, and things like answers can be an enormous relief or at least point one in the right direction. This is why I've come to all of you, and it's brought me more information than I had before- thank you!!

He can't help you. That should not be confused with not caring.

You are sub-surgical and may not be progressing. You may never hit surgical range. If you have pain then PT might be more likely to help you than even surgery.

LindaRacine
01-26-2011, 12:20 PM
Hi everyone!

First time post, I just discovered this forum yesterday and am quite excited about the chance to speak with other curvy people! I'm a 38 yr old male, many signs were there when I was younger but they were never understood for what they were. In the last ten years I've felt that something was wrong with my back, but it was only last fall when it was given a name. My health insurance only exists because of low income, so I didn't get a lot of choices for specialists. I don't mean to badmouth the spine specialist I've seen, but he seemed rather detached and pressed for time. He pretty much brushed off my inquiry about what degrees the curves were and what classification of scoliosis it is. It might not be a big deal to him, but my life seems to rotate around my back these days so I would love a little information.

I would like to know what kind of curve it is because certain exercises (Yoga For Scoliosis, in particular) require us to know so we can properly adjust them to suit our needs. Would we just call this a right thoracic curve and a minor left lumbar- or is the lumbar curve enough to call it an "S" curve?

A rough sense of the degrees would be helpful so I can have some sense of how things are progressing (or not). Perhaps some of you would know from your own x-rays and might be able to give me a rough sense. I'd appreciate any help anyone can offer.

sincerely,

~Paul

Hi Paul...

I think you have a double major curve, with both curves being under 30 degrees.

Almost all xrays are shown with the left side on right (you see the L mark in the lower righthand corner). I would assume it's because the xray was taken from the back, through the body. So the L means that it's the Left hand side, facing forward.

Regards,
Linda

pmc
01-26-2011, 01:12 PM
Hi Linda!

When you say double major curve, does that mean you'd say the lumbar curve was not so much a compensating curve... possibly structural?

The X-ray was from the front.

thanks!

pmc
01-26-2011, 01:14 PM
If you have pain then PT might be more likely to help you than even surgery.

I tend to describe it as intense fatigue and soreness, though if I've had a long day and/or had to lift more than I'd prefer it blends more into the realm of pain.

thanks!

LindaRacine
01-26-2011, 03:21 PM
Hi Linda!

When you say double major curve, does that mean you'd say the lumbar curve was not so much a compensating curve... possibly structural?

The X-ray was from the front.

thanks!
Yes, it's possible both the curves are structural. A good specialist might stiil be able to tell you whether it is.

-Linda

Ballet Mom
01-26-2011, 03:38 PM
Hi Linda!

When you say double major curve, does that mean you'd say the lumbar curve was not so much a compensating curve... possibly structural?

The X-ray was from the front.

thanks!

You should definitely get a copy of your chart for your own records. You really should get the actual information from the surgeon regarding your own curve.

Except for the shadowy "kink" at the top of your thoracic curve, which I don't know what is, I could swear I was looking at my daughter's x-ray. And all doctor's and orthotists that she has seen have always called the lower curve a compensatory curve and are uninterested in it. Her thoracic curve varies from 29-32 degrees and her lumbar curve varies from 19-22 degrees. A difference of ten degrees between the two curves.

So basically even only ten degrees (or perhaps less) difference in the upper and lower curves can be the difference between it being considered a double major or not.

I believe a double major is two structural curves of approximately the same size. A structural curve means it won't straighten out on its own when bent. I don't know of any characteristics other than being the same size that differentiates them on x-ray without doing bending tests for curve flexibility and being x-rayed at the same time. Maybe Linda can explain more to us.

green m&m
01-26-2011, 07:00 PM
Except for the shadowy "kink" at the top of your thoracic curve, which I don't know what is, I could swear I was looking at my daughter's x-ray.

That shadow is just the space between the lungs :)

pmc
01-27-2011, 09:21 AM
You should definitely get a copy of your chart for your own records. You really should get the actual information from the surgeon regarding your own curve.

Except for the shadowy "kink" at the top of your thoracic curve, which I don't know what is, I could swear I was looking at my daughter's x-ray. And all doctor's and orthotists that she has seen have always called the lower curve a compensatory curve and are uninterested in it. Her thoracic curve varies from 29-32 degrees and her lumbar curve varies from 19-22 degrees. A difference of ten degrees between the two curves.

So basically even only ten degrees (or perhaps less) difference in the upper and lower curves can be the difference between it being considered a double major or not.

I believe a double major is two structural curves of approximately the same size. A structural curve means it won't straighten out on its own when bent. I don't know of any characteristics other than being the same size that differentiates them on x-ray without doing bending tests for curve flexibility and being x-rayed at the same time. Maybe Linda can explain more to us.

Thank you once again! I had tried in my own way (photoshop over the x-ray) to try and get some sense of the angles, and my best guess was 30 and 20 degrees. It's helpful to have all of you compare to curves you're familiar with- now I have some sense of where I stand withing the spectrum of things.

The surgeon/spine specialist didn't give me any reports, I asked him about the angles and type of curve and he managed to wriggle out of an answer. Maybe I could contact a nurse or assistant there and see if they can send me what they have.

pmc
01-27-2011, 09:23 AM
That shadow is just the space between the lungs :)

Ahhh, I was wondering what that was, too! Thanks for that. :)

Ballet Mom
01-28-2011, 10:56 AM
The surgeon/spine specialist didn't give me any reports, I asked him about the angles and type of curve and he managed to wriggle out of an answer. Maybe I could contact a nurse or assistant there and see if they can send me what they have.

The surgeon will never give you any reports unless you request them, usually from their staff, like the person at the front desk. And it's not necessarily a report, it's simply a copy of the chart with the degrees listed on it by date of visit, although that varies by surgeon. It usually costs a little bit of money to get copies made. If you called and asked some questions, they probably would just tell you the angle(s) over the phone, and yes that call would be directed to the person who answered the phone, not the surgeon himself. They are usually quite helpful.

I have never been given any specific information about curve type either. I searched around though and it looks like my daughter has a "false double-major curve" with a structural thoracic curve and a compensatory lumbar curve. Apparently a side-bending film is required to determine that, but since your lumbar curve appears to be less than 25 degrees without bending, it's sure to be less than 25 degrees on bending. So basically whether you have a false double major curve would depend on whether or not you have kyphosis greater than 20 degrees from T10-L2. If you do, then the lumbar curve would be considered structural and your curve would be considered a true double major curve. I suppose all this could change if curves progress at some point.

Anyhow, here's one of the great resources I found if you want to read further about it. The information starts on page 68 at "Coronal Balance in Adolescent Idiopathic Scoliosis". I suppose this might even be different if you had some other type of scoliosis other than AIS....but it's a start anyway. Remember that this is NOT professional medical advice and could possibly be incorrect.

http://books.google.com/books?id=cZu3_EezS_wC&pg=PA69&lpg=PA69&dq=false+double+major+lumbar+%22C%22&source=bl&ots=JrlNuuun2W&sig=juqB_6ZGFH7QvoOqKP-70pi0ip0&hl=en&ei=BFFCTbWtCYSesQPhpJSlCg&sa=X&oi=book_result&ct=result&resnum=6&ved=0CDQQ6AEwBQ#v=onepage&q=false%20double%20major%20lumbar%20%22C%22&f=false

pmc
01-29-2011, 09:30 AM
Many thanks, Ballet Mom, I appreciate all of the information.

When I got my X-Rays, it was in the form of a CD, but they told me that it would be without a report. Unfortunately it wasn't Mac compatible, so I had to find a PC to view the files. But, that wouldn't work because one has to be online..... so, of all places for me to see my X-Rays for the first time- a pizza joint with Wi-Fi. Not my ideal place, it was a little surreal to say the least.

It wasn't until about a month later could I see the spine specialist again, but he didn't seem to have any numerical data to share at that point. I'll call them, thanks!

Pooka1
01-29-2011, 09:38 AM
When I got my X-Rays, it was in the form of a CD, but they told me that it would be without a report.

Have you checked whether there is a short (few sentence) write-up on CD?

There is a short radiologist (not surgeon) report with each radiograph on both CDs for my daughters. It states the angles and whether there was a change from the previous one. Sometimes there is a stray comment about soft tissue or something besides spine also. They are only a few sentences but every radiograph has an accompanying write-up.

It was eye-opening to see those little reports because clearly the surgeon was not using them and did his own measurements and made different conclusions about progression or non-progression.

Ballet Mom
01-29-2011, 03:25 PM
That's interesting that there are surgeons that use radiologists for their scoliosis x-rays. We've been to three different surgeons' offices and they all have an x-ray room right next to all the exam rooms. No radiologist involved.

hdugger
01-29-2011, 04:00 PM
It's probably more common in a hospital setting. Our surgeon at OHSU sent us downstairs for an xray (no machines in his office) so we got both the radiologist's and the doctor's reading. Oddly, those two readings were miles apart - our surgeon read the curve as 57 and the radiologist read it as 45.

Ballet Mom
01-29-2011, 04:23 PM
One of those surgeons was based in a hospital and he had an x-ray room right next to the exam rooms. He would come back to the computer next to the x-ray curtain and look at the x-rays as they were available. No radiologist involved. In fact, it seems like a waste of money to have a radiologist involved in the process. Maybe that's because there isn't the quantity of orthopedic patients necessary to make it cost-effective. Nevertheless, it seems very "union-like" to have to have a radiologist read the x-ray prior to the orthopedic surgeon.

Pooka1
01-29-2011, 05:39 PM
It's probably more common in a hospital setting. Our surgeon at OHSU sent us downstairs for an xray (no machines in his office) so we got both the radiologist's and the doctor's reading. Oddly, those two readings were miles apart - our surgeon read the curve as 57 and the radiologist read it as 45.

To read these radiologist reports after the fact and after what I had as my kids' progression history from the surgeon was very eye opening. What I wrote contemporaneous with these surgeon visits (and therefore was fresh in my head) is quite different from the radiologist reports. An unbiased observer would never conclude they were for the same patient. It's that divergent in my opinion.

It is very clear there are schools of thought w.r.t. how to measure these things. The bottom line is stick with any one school and don't mix schools.

What is not clear is why the insurance pays for the radiologist readings when they must realize the surgeon is measuring these things himself. I have seen the surgeon measuring radiographs prior to him coming in with the radiographs.