rotation without curve?

[flowerpower]

I took my daughter to our ped. dr. for a sports physical. She had my daughter bend over to check her back and we both noted that the right side seems a bit higher than the left. She wanted an x-ray done - the spine looks straight.

Last Dec. at Joe's 1 yr. post-op. I had Dr. Newton check all the kids. When he checked her back I had noted then that the right side looked a teeny bit higher than the left. He dismissed it because the spine looked straight on x-ray.

She started menses last Oct. and has grown quite a bit since than. There is a slight asymetry on the right upper part of sternum, (which both drs. have seen and dismissed as no cause for concern.) When I mentioned this to the ped. dr. she asked me to bring her by the office again so she could look at her again.

Anyway, I was wondering if there could be rotation of the spine with no measurable curve?

Renee

[gerbo]

i am sure i have picked up that most people have a slight rotation of the spine, which has to do with the assymmetry of the human development and human body (i.e. left and right are not the same, with heart situated more towards the left etc) With other words; sounds quite normal to me.

[Rayknox]

Rotations of the spine do not always show up on x-rays and these rotations are not normal.

[gerbo]

this is where i got it from;

Analysis of Preexistent Vertebral Rotation in the Normal Quadruped Spine.

Diagnostics

Spine. 31(20):E754-E758, September 15, 2006.
Kouwenhoven, Jan-Willem M. MD *; Vincken, Koen L. PhD +; Bartels, Lambertus W. PhD +; Meij, Bjorn P. DVM, PhD ++; Oner, F Cumhur MD, PhD *; Castelein, Rene M. MD, PhD *
Abstract:
Study Design. In this CT study, vertebral rotation was analyzed in the transverse plane of the normal, nonscoliotic canine spine with a computer-based measurement method.

Objectives. To determine if a rotational pattern exists in the normal, nonscoliotic quadruped spine, similar to what is seen in humans.

Summary of Background Data. Idiopathic scoliosis does not occur in quadrupeds. In humans, the normal, nonscoliotic spine shows a preexistent pattern of vertebral rotation, which corresponds to the most prevalent curve types of idiopathic scoliosis. Since this rotational tendency has only been demonstrated in humans, it is not clear if it can be considered as a part of the pathogenesis of idiopathic scoliosis or as a normal anatomic feature.

Methods. CT scans of the thorax of 42 dogs without clinical or radiologic evidence of scoliosis were used to measure axial vertebral rotation from T1-T13 with a previously developed computer-based CT measurement method.

Results. The results of this study demonstrated a predominant rotation to the right of the upper, mid, and lower thoracic vertebrae of the normal canine spine. The mean vertebral rotation angles differed significantly from zero degrees rotation at level T1, from level T4-T7, and from T11-T13.

Conclusions. The normal spine of quadrupeds shows rotation of the thoracic vertebrae with a preferred direction to the right, similar to what is seen in humans. Since idiopathic scoliosis does not exist in quadrupeds, this preexistent rotation seems to be a physiologic process in normal spinal development, independent of the pathogenesis of scoliosis.

[Rayknox]

I regularly treat patients with(often severe) rotations esp. in the lumbar spine but also thoracic, which have not shown up with either x-ray or MRI. They are easily identified with the tamars tool. These patients end up eventually with curvatures of varying degrees.(and pain)
Could canine rotations be due to the gait. I have seen long very slightly curved (rotated) spines in sports people that do repetitive actions such as fast bowlers.

[gerbo]

Summary of Background Data. Idiopathic scoliosis does not occur in quadrupeds. In humans, the normal, nonscoliotic spine shows a preexistent pattern of vertebral rotation, which corresponds to the most prevalent curve types of idiopathic scoliosis

so it is stated here that a degree of rotation is normal in humans

[Rayknox]

I would be interested in reading the study that came to that conclusion. And the degree of rotation they are talking about.
The rotations I am finding are definitely not normal as I have large numbers of patients to compare.

[structural75]

Hey Guys,
I don't want to get too involved in this because in the end it's a matter of 'opinion' as to whether these rotations are detrimental. And I don't care to have another "study debate". The only thing that study suggests is that the individuals performing/concluding on it are not open to consider the possible complications and relevance of rotations with other musculoskeletal/physiologic problems... With all due respect, typical of conventional MDs who treat symptoms, not the cause. So until something goes 'wrong' and presents itself as a problem, they won't consider the potential contributing factors.

As a practitioner who works regularly with these types of rotations I can say this... . I do believe that having a slight rotation is common due to asymmetry in anatomical features (heart, lungs, liver, stomach... to name a few) as well as handedness (right or left handed individuals, etc.). They are also influences by occupational habits/strains, injuries (compensations resulting from) and other non-traumatic and traumatic factors.

In children these factors don't typically present themselves to a remarkable degree for the obvious reasons (kids don't have jobs, etc), so when I see these stronger presentations I do believe they are of relative concern... at least worthy of acknowledging and monitoring if nothing else.

Rotations caused by any of these factors can in fact create problems of infinite variety... shoulder problems, neck problems, breathing difficulties, etc, etc.... one can't expect the body to function optimally with such imbalances. I won't go into my 'clinical' evidence/reasoning for this, but I'll just say that.

They often can be treated successfully with varying degrees of correction. Yes, I've witnessed and accomplished this myself.

Renee,

It's worth keeping an eye on... follow up as you see fit. Many people with rotations that are considered "normal" do not present with a 'rib hump' that is noticeable... so when one is noticeable it is a good idea to be mindful and seek out Drs/professionals who share your concerns. And yes, rotations can occur without a lateral bend as in scoliosis.... it's perfectly 'normal' biomechanics.

Best wishes
Structural

[Rayknox]

Renee,
structural is correct. Monitor the situation. The rib hump does not seem normal.

[gerbo]

i think structural sums it up quite nicely

I think we mentioned this before; one wonders whether this pre-existing rotation is one of the main contributing factors in the development of idiopatic scoliosis in humans, who "unnaturally" have evolved in walking on two legs (rather than 4), and are much more exposed to the forces of gravity for that reason. Could there also be a further vulnerability due to the exacerbation of kyphosis/ lordosis due to gravity? Not sure whether other mammals have similar patterns as humans. What do you think structural?

[flowerpower]

Thanks guys,

I too, have understood that there is slight rotation in a normal spine. In fact, when my daughter was examined by the ortho surgeon last Dec. that was his comment. Do you think the asymetry can be caused by playing softball? She was pitching quite a bit during winter & spring. In previous inquiries, one dr. said yes, it could be attributed to softball and the other said no. I don't think so though, I've not seen or heard of this with other players.

I will take her back again soon, the dr. wants to see her again before she refers us to an ortho. I'm not overly worried but was surprised by the dr.'s startled reaction.

[structural75]

Gerbo,

My goodness... There are so many potential factors that I think it's safe to say the variables of causation are numerous.

I do feel that these primary rotations, which occur to varying degrees in humans, could possibly initiate an ideopathic scoliosis. As could an excessive kyphosis/lordosis. If you take any pattern into an extreme like that you run a higher risk of deviation from a balanced point. Also, give the nature of spinal mechanics, when the spine rotates, although it doesn't have to side bend, it will have a naturally tendancy to want to go into a side bend given the asymmetric forces acting on either side of the spine. Couple that with the force of gravity and you've got a recipe for a scoliotic pattern to develop. Embryological development is also a factor in my opinion. As life unfolds, literally and figuratively, there is a lot of potential room for error. Positioning of the fetus can affect the development of the connective tissue/fascai that houses all of our internal parts from bone to muscles to nerves and organs. A slight or severe aberrant tension in this network on one side verse the other, front to back, inside to outside, etc. can possibly create asymmetric growth of the body. There is also the possibility of organs not unfolding adequately which would also alter structural balance. On and on and on... .

I do strongly believe that gravity plays a key role in the progressive tendancies of scoliosis. Some are able to resist it better than others and there are certainly other factors involved in that. But we often hear ourselves asking 'why' scoliosis progresses all of the sudden when it had been stable for a period of time (or at least in brace). I think it's to be expected that when one removes a brace, regardless of whether they've finished growing, the possibility for progression still exist as long as a curve still exists. And during that physical struggle the body is enduring with gravity one can also expect to experience a variety of types of pain along with it as the body's tissues exert unusually high effort to resist that force. Tissue is overstrained, neurogenic inflammation occurs in the peripheral nerves within the soft tissue as they move along their way to various regions of the body. Etc., etc., etc....

As for other mammals, I haven't done my homework on that one to speak much about it. ???

structural