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susancook
12-18-2012, 11:26 PM
Call me confused. Does anyone have a good article to help me understand how sagittal and coronal imbalace [?balance] can change dramatically and cobb angles stay the same? Thought that I understood this, but not so....

Went for my one year checkup and balances changes, so was sure that angles had changed. Preliminary angle checks appear that they are roughly the same, but I'm WAY OFF in balance [shift to the right and front].

Thanks
Susan

titaniumed
12-19-2012, 12:30 AM
Susan

Here are x-rays of various cases. Look for examples of sagittal and coronal imbalance in the various cases. Read through all the examples.
http://www.espine.com/adult-scoliosis-cases.htm

Having an imbalance with your plumb line is another problem. Separate the two problems.

Sagittal and coronal imbalance being one problem.
Scoliotic curves is another problem.

It can be a tough situation after you start leaning over.

Ed

susancook
12-19-2012, 12:53 AM
Susan

Here are x-rays of various cases. Look for examples of sagittal and coronal imbalance in the various cases. Read through all the examples.
http://www.espine.com/adult-scoliosis-cases.htm

Having an imbalance with your plumb line is another problem. Separate the two problems.

Sagittal and coronal imbalance being one problem.
Scoliotic curves is another problem.

It can be a tough situation after you start leaning over.

Ed

Thanks. Like you said...I asked for a disc and they will send me one in a couple of days. Dr. Hart showed me the frontal and lateral views. The plumb lines were WAY off. He said that it looked like I was leaning forward....I think that I lean backwards...actually my lower half leans forward and my upper half leans backwards.

I read some medical articles in spine magazines [on Google] and disc degeneration can cause the changes in sag and coronal balance without affecting Cobb angle.

What do I do?????

MRI scheduled. I will get a second opinion. He said something like, "The decision on whether to have surgery or not is yours, but I can't imagine why you wouldn't want surgery." I was sitting on the floor as the chair in the exam room was too uncomfortable. It's difficult to listen and take notes when you're and "8" on the pain scale.

I need a weegee board....Susan

jrnyc
12-19-2012, 05:44 PM
susan, question....did your curves increase in size?
i thought that was one of the concerns you mentioned
before you saw the doctor...???????

jess

jrnyc
12-19-2012, 05:47 PM
TiEd...i thought everyone with scoli has plumb lines that are off...
????????????????
when i was told by a doctor that when i walked into his office,he noticed
my plumb line was off just by looking at me, i thought nothing of it...
figured it is true for all scolis...

IS IT true for all scolis....??????????????????

jess

TAMZTOM
12-19-2012, 06:57 PM
Call me confused. Does anyone have a good article to help me understand how sagittal and coronal imbalace [?balance] can change dramatically and cobb angles stay the same? Thought that I understood this, but not so....

Went for my one year checkup and balances changes, so was sure that angles had changed. Preliminary angle checks appear that they are roughly the same, but I'm WAY OFF in balance [shift to the right and front].

Thanks
Susan

Your body is compensating for the curves. Instead of, for example, weight loading your lumbar curve, the left hip can subconsciously be shifted to the left, the body and mind's attempt to still have the spine function as a load bearer. Pulling the hip back towards the mid-line would likely result in the lumbar curve increasing.

titaniumed
12-19-2012, 09:22 PM
TiEd...i thought everyone with scoli has plumb lines that are off...



No.

Not me. I had a perfect S with no lordosis or kyphotic abnormalities. I did have the common low left shoulder which is a giveaway when looking for scolis...

Perfect plumb would be to hang a string from T1 dead center and have the string fall dead center at the bottom of the spine. Top to bottom only, the curves in the middle do not count. Actually, the string should be perfectly centered between the feet in the standing position.
http://en.wikipedia.org/wiki/Plumb-bob

Look at dotted line being 1.7cm off at bottom
http://radiographics.rsna.org/content/30/7/1823/F10.expansion.html

I have always had perfect balance and could walk a tightrope even right now. Maybe the skiing had something to do with that. Funny also that in skiing ice, you lean forward, and in powder you lean back. Its something I have done all my life. Skiing is all about balance and force transfer.

Plumbline study....in adults over 50
http://www.ncbi.nlm.nih.gov/pubmed/19564757

Like Tom said, compensation happens. Just the slightest injury can trigger the mind to shift the body. Stepping off a curb wrong or a long plane ride can really wipe a person out. I have always struggled after long plane rides.....

Ed

jrnyc
12-19-2012, 09:39 PM
thanks for the answer, Ed...
i think it is strange that i supposedly have good balance even with
what the surgeons said is hypokyphosis...and listhesis...
and curves of 42 and now 70...
of course, that was 2 years ago...
who knows how good my balance is now...
if i didn't have the pain, darned if i'd care...

wishing you and everyone on forum Merry Christmas and Happy 2013...
(i never did believe that the world would end this Friday....December 21st...)

jess...& Sparky

titaniumed
12-19-2012, 10:04 PM
It's difficult to listen and take notes when you're and "8" on the pain scale.



Susan

Im so sorry about the pain. I know it can be just brutal.

Go get a massage. Do you know somebody good? Take a 45 minute hot soak in really hot water and then have a light massage. Try to relax some to try to get the pain levels down. Deep breaths! Find a warm water pool. Get a foam topper for your bed. Slow down on the plane rides....

Plane rides especially half way around the world are killers on the spine. Add turbulent weather on the flight, and pain is pretty much guaranteed.

Have you tried Blue stuff or Tiger balm? These products help...Dont give them your phone # as they keep calling back all the time.
http://www.bluespringwellness.com/

You could see another surgeon for a second opinion.

Try to take it easy right now. Deep breaths!
Ed

susancook
12-19-2012, 10:33 PM
Thanks for everyone's support. Gravity is not my friend...a heating pad does feel good. The surgeon gave me some Dilaudid to try. I do have a foam topper. Think that we should buy a hot tub. I had a massage on last Wednesday and had a fear of being hurt during the massge. Massage therapist said, "Wow, there's something going on with your back!" I gave her a tip anyway.

Susan

susancook
12-19-2012, 10:37 PM
susan, question....did your curves increase in size?
i thought that was one of the concerns you mentioned
before you saw the doctor...???????

jess

You are right...somehow, I thought that the great increase in my right leaning must be due to the curve changing. My right fingers touch my knee and my left fingers are about 4 inches above my knee. I've been doing a lot of medical journal reading on "balance" and the change in us older folks can be due to futher disintegrating discs. Swell.
Susan

LindaRacine
12-19-2012, 11:19 PM
Most people with idiopathic scoliosis do not have coronal imbalance. It's relatively unusual, especially in kids, for someone with idiopathic scoliosis to not be balanced.

susancook
12-24-2012, 02:53 AM
I just had my 1 year follow-up x-ray and here are the results:

Report of my xray from OHSU, just found it in my Inbox:

IMPRESSION:

Unchanged S-shaped scoliosis of the thoracic and lumbar spine.
Increased positive coronal imbalance when compared to the previous
exam. [Now 11.2 cm, last year: 4.1cm]

Exaggerated lower thoracic kyphosis, unchanged. Severe multilevel
lower thoracic and lumbar spine degenerative disk disease.

Attending Radiologists: Craig Brooksby,
Author: Craig Brooksby,

So, now I am confused. I knew that my spine problem had worsened as I lean markedly to the right now. My right shoulder is MUCH lower than my L shoulder. I really look pitiful as I look in the mirror. Well, I assumed that the change would be that my curve had progressed, but it is the same as last year. Looks like my discs are greatly degenerating ;+[, so are they the cause of the change in coronal balance? If so, then why isn't my curve different? I have spent hours on the internet trying to read medical articles and I cannot find the answer.
Can someone help me to understand this?

Thanks,
Susan

Pooka1
12-24-2012, 09:29 AM
Susan,

There are three planes of motion:

1. Side to side - this is the curvature of scoliosis as viewed from the front or back.

2. Front to back - this is the lean forward or backward as viewed from the side.

3. Axial plane - this the rotation as viewed from looking straight down above the head.

You have some smallish "S" curve that is now leaning more forward and to the right. So the only thing that has changed in #2. These three things are not is absolute tight lock step. So the whole assembly of the S portion of your curve has been displaced forward and to the right. There is no change needed withing that mass to simply have it collapse forward. Essentially your spine is not curving more but is moving more forward and to the right as a unit and is bending about a point in your lower thorax (increased kyphosis at that point).

Because your curve is smallish, it is not particularly relevant to the surgical decision as I understand this. You would need fusion with no curve and the same DDD to hope to get pain relief as far as I can tell. You seem to be focused on curvature because you are dealing with a bunch of people whose surgical decision rests in part on increasing curvature. None of that applies to you as I understand this. The curve is incidental to your severe DDD. Linda will correct me if I'm wrong.

Because you keep getting confused about this, I think rather than a scoliosis group, you might get more relevant answers on a DDD group. You need to talk to DDD patients who have been fused or not fused. That is your main issue.

Good luck.

LindaRacine
12-24-2012, 12:09 PM
Susan... I've merged your two threads on this topic. Whenever possible, please keep like topics together as a single thread, as it can get pretty confusing otherwise. Thanks.

--Linda

LindaRacine
12-24-2012, 12:13 PM
Your body is compensating for the curves. Instead of, for example, weight loading your lumbar curve, the left hip can subconsciously be shifted to the left, the body and mind's attempt to still have the spine function as a load bearer. Pulling the hip back towards the mid-line would likely result in the lumbar curve increasing.

In this case, I think it's more likely that the body is compensating for pain (not curves).

susancook
12-24-2012, 03:29 PM
Thanks for everyone's attempts to help me understand the chsnge.
Susan

susancook
12-24-2012, 04:01 PM
Susan... I've merged your two threads on this topic. Whenever possible, please keep like topics together as a single thread, as it can get pretty confusing otherwise. Thanks.

--Linda

Thanks Linda...sorry that I am being confusing...that pretty much sums uo how I feel! Susan

susancook
12-24-2012, 04:06 PM
In this case, I think it's more likely that the body is compensating for pain (not curves).

This will be the number 1 question that I will ask on my second opinion. Why the change in balance when there is no change in the curve? How can disks degenerate more and the curve stays the same and yet I lean markedly to the Right [changed coronal balance]. Thanks for trying to help me understand all of this. Susan

Pooka1
12-24-2012, 04:23 PM
This will be the number 1 question that I will ask on my second opinion. Why the change in balance when there is no change in the curve? How can disks degenerate more and the curve stays the same and yet I lean markedly to the Right [changed coronal balance]. Thanks for trying to help me understand all of this. Susan

You have an increasing lean and bad pain. The answer to why your sagittal balance is worsening but not your curves is irrelevant to the DDD because of the pain and lean. I don't think there is any conservative solution that then becomes available and effective depending on what the answer to that question is. I think that is why Hart said what he did to you. You have one option remaining apparently according to him.