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Understanding change in sagittal and coronal balance & little change in cobb angle

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  • Understanding change in sagittal and coronal balance & little change in cobb angle

    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
    Adult Onset Degen Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Sev disc degen T & L stenosis

    2013: T3- S1 Fusion w/ ALIF L4-S1/XLIF L2-4, PSF T4-S1 2 surgeries
    2014: Hernia @ ALIF repaired; Emergency screw removal SCI T4,5 sec to PJK
    2015: Rev Broken Bil T & L rods and no fusion: 2 revision surgeries; hardware P. Acnes infection
    2016: Ant/Lat Lumbar diskectomy w/ 4 cages + BMP + harvested bone
    2018: Removal L4,5 screw
    2021: Removal T1 screw & rod

  • #2
    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
    49 yr old male, now 63, the new 64...
    Pre surgery curves T70,L70
    ALIF/PSA T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

    Comment


    • #3
      Originally posted by titaniumed View Post
      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
      Adult Onset Degen Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Sev disc degen T & L stenosis

      2013: T3- S1 Fusion w/ ALIF L4-S1/XLIF L2-4, PSF T4-S1 2 surgeries
      2014: Hernia @ ALIF repaired; Emergency screw removal SCI T4,5 sec to PJK
      2015: Rev Broken Bil T & L rods and no fusion: 2 revision surgeries; hardware P. Acnes infection
      2016: Ant/Lat Lumbar diskectomy w/ 4 cages + BMP + harvested bone
      2018: Removal L4,5 screw
      2021: Removal T1 screw & rod

      Comment


      • #4
        susan, question....did your curves increase in size?
        i thought that was one of the concerns you mentioned
        before you saw the doctor...???????

        jess

        Comment


        • #5
          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

          Comment


          • #6
            Originally posted by susancook View Post
            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.
            07/11: (10yrs) T40, L39, pelvic tilt, rotation T15 & L11
            11/11: Chiari 1 & syrinx, T35, L27, pelvis 0
            05/12: (11yrs) stopped brace, assessed T&L 25 - 30...>14lbs , >8 cm
            12/12: < 25 LC & TC, >14 cms, >20 lbs, neuro symptoms abated, but are there
            05/13: (12yrs) <25, >22cms height, puberty a year ago

            Avoid 'faith' in 'experts'. “In consequence of this error many persons pass for normal, and indeed for highly valuable members of society, who are incurably mad...”

            Comment


            • #7
              Originally posted by jrnyc View Post
              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/conten...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
              49 yr old male, now 63, the new 64...
              Pre surgery curves T70,L70
              ALIF/PSA T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
              Dr Brett Menmuir St Marys Hospital Reno,Nevada

              Bending and twisting pics after full fusion
              http://www.scoliosis.org/forum/showt...on.&highlight=

              My x-rays
              http://www.scoliosis.org/forum/attac...2&d=1228779214

              http://www.scoliosis.org/forum/attac...3&d=1228779258

              Comment


              • #8
                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

                Comment


                • #9
                  Originally posted by susancook View Post
                  It's difficult to listen and take notes when you're and "8" on the pain scale.
                  Susan

                  I’m 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...Don’t 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
                  49 yr old male, now 63, the new 64...
                  Pre surgery curves T70,L70
                  ALIF/PSA T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
                  Dr Brett Menmuir St Marys Hospital Reno,Nevada

                  Bending and twisting pics after full fusion
                  http://www.scoliosis.org/forum/showt...on.&highlight=

                  My x-rays
                  http://www.scoliosis.org/forum/attac...2&d=1228779214

                  http://www.scoliosis.org/forum/attac...3&d=1228779258

                  Comment


                  • #10
                    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
                    Adult Onset Degen Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Sev disc degen T & L stenosis

                    2013: T3- S1 Fusion w/ ALIF L4-S1/XLIF L2-4, PSF T4-S1 2 surgeries
                    2014: Hernia @ ALIF repaired; Emergency screw removal SCI T4,5 sec to PJK
                    2015: Rev Broken Bil T & L rods and no fusion: 2 revision surgeries; hardware P. Acnes infection
                    2016: Ant/Lat Lumbar diskectomy w/ 4 cages + BMP + harvested bone
                    2018: Removal L4,5 screw
                    2021: Removal T1 screw & rod

                    Comment


                    • #11
                      Originally posted by jrnyc View Post
                      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
                      Adult Onset Degen Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Sev disc degen T & L stenosis

                      2013: T3- S1 Fusion w/ ALIF L4-S1/XLIF L2-4, PSF T4-S1 2 surgeries
                      2014: Hernia @ ALIF repaired; Emergency screw removal SCI T4,5 sec to PJK
                      2015: Rev Broken Bil T & L rods and no fusion: 2 revision surgeries; hardware P. Acnes infection
                      2016: Ant/Lat Lumbar diskectomy w/ 4 cages + BMP + harvested bone
                      2018: Removal L4,5 screw
                      2021: Removal T1 screw & rod

                      Comment


                      • #12
                        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.
                        Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
                        ---------------------------------------------------------------------------------------------------------------------------------------------------
                        Surgery 2/10/93 A/P fusion T4-L3
                        Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

                        Comment


                        • #13
                          Curve stable but coronal balance worsened....help me understand this!

                          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
                          Adult Onset Degen Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Sev disc degen T & L stenosis

                          2013: T3- S1 Fusion w/ ALIF L4-S1/XLIF L2-4, PSF T4-S1 2 surgeries
                          2014: Hernia @ ALIF repaired; Emergency screw removal SCI T4,5 sec to PJK
                          2015: Rev Broken Bil T & L rods and no fusion: 2 revision surgeries; hardware P. Acnes infection
                          2016: Ant/Lat Lumbar diskectomy w/ 4 cages + BMP + harvested bone
                          2018: Removal L4,5 screw
                          2021: Removal T1 screw & rod

                          Comment


                          • #14
                            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.
                            Last edited by Pooka1; 12-24-2012, 08:31 AM.
                            Sharon, mother of identical twin girls with scoliosis

                            No island of sanity.

                            Question: What do you call alternative medicine that works?
                            Answer: Medicine


                            "We are all African."

                            Comment


                            • #15
                              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
                              Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
                              ---------------------------------------------------------------------------------------------------------------------------------------------------
                              Surgery 2/10/93 A/P fusion T4-L3
                              Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

                              Comment

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