Announcement

Collapse
No announcement yet.

Bending xrays question

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • Bending xrays question

    Hi everyone!

    My surgery is getting closer now (it's scheduled for Sept. 23rd!), and next week I have an appointment for bending xrays. According to my ortho's nurse, she has to go with me in order to make sure I am positioned correctly for these films. I am a bit confused - I thought bending xrays were just me bending to each side to check for curve flexibility? Why would I need to be positioned? The appointment letter I received also listed six separate angles/poses/whatever you call 'em.

    What has your experience been with bending xrays, and what did they tell you exactly?

    Thanks and have a great day!

    --Steph
    dx age 13, wore Charleston Bending Brace until 17
    34* degree thoracolumbar curve has increased to 52* since skeletal maturity
    anterior fusion/instrumentation planned for 09-23-09
    likely T10 - L3 or L4
    --Steph

    Anterior surgery 9/23/09
    Fused T10 - L3

  • #2
    Hi Steph...

    According to the Spinal Deformity Group's "Radiograhic Measurement Manual," these are the xrays that might be taken (in addition to the standard P/A and lateral views):
    2a) Push Prone - apply pressure to push on the structural curve(s) while stabilizing point(s) on the opposite side of the body. For Thoracic curves, push lower than horizontal to the apex of the curve -- push on ribs that attach to the apex. Stabilize the opposite pelvis and axilla. For thoracolumbar/lumbar curves, push on the TL/L curve between the rib cage and iliac crest. Stabilize the opposite pelvis and axilla. For Double Major curves, push on both curves - stabilize the axila opposite the MT curve and the pelvis opposite the TL/L curve.

    2b) Supine A/P (standard torso films, but patient lays down instead of standing).

    2c) Fulcrum Bend (Thoracic Curve). Patient side bending over a bolster positioned under the most prominent part of the ribcage (ribs that attach to apex of curve). The arms are positioned overhead and the body should be relaxed over the bolster which is firm enough so that the shoulder and hip does not touch the x-ray table.

    2d) Traction A/P. Although bending films are the most common method to assess curve flexibility, traction films may also be useful. Use of a head halter or simply pulling from the axilla of both upper extremities is effective for creating the cephalad vector. The force applied should be firm but not painful.

    2e) Supine Hyperextension Crosstable Lateral (bolster under apex of kyphosis).

    Aren't you glad you asked? ;-) Seriously, there's nothing about which you should be concerned.

    Regards,
    Linda

    Regards,
    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


    • #3
      What if you think they were not performed correctly?

      What if you believe the fulcrum bending xray was not performed correctly?
      Is it important that they get this right and would it affect the overall decision for the amount of correction to be achieved for surgery. The reason I ask is that I don't think that my daughters shoulders were off the table or her hips either really. The correction for her lumber curve was to 14degrees but her thoracic was 24degrees. The doctor commented that he would try and correct to about 20 for both so that they are balanced. Is the final decision for the amount of correction made on the operating table or do they go by the bending xrays when deciding how far they will correct to?
      Regards
      Donna....Gabs Mum.
      Mother to 14 year old daughter, Gabrielle (Gabby).
      Discovered her scoliosis on her 14th Birthday in February 2009. Due to be operated on for curves of 57 and 54 degrees (S Curve) in December 2009 with Dr. Askin in Brisbane.

      Comment


      • #4
        Originally posted by gabs mum View Post
        What if you believe the fulcrum bending xray was not performed correctly?
        Is it important that they get this right and would it affect the overall decision for the amount of correction to be achieved for surgery. The reason I ask is that I don't think that my daughters shoulders were off the table or her hips either really. The correction for her lumber curve was to 14degrees but her thoracic was 24degrees. The doctor commented that he would try and correct to about 20 for both so that they are balanced. Is the final decision for the amount of correction made on the operating table or do they go by the bending xrays when deciding how far they will correct to?
        Regards
        Donna....Gabs Mum.
        Hi Donna..

        Essentially all decisions are made in the OR. I wouldn't worry about the xrays not being taken correctly. The book I quoted from is really a best practices text. That doesn't mean the films your daughter had weren't of value. If the surgeon finds that the patient is more flexible than what they saw in the films, they'll get better correction.

        Good luck with the surgery.

        Regards,
        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


        • #5
          Thankyou

          Thats exactly what I needed to hear. Thanks Linda. It's terrible sitting around trying to guess these things. This forum is soooo valuable.
          Regards
          Donna.
          Mother to 14 year old daughter, Gabrielle (Gabby).
          Discovered her scoliosis on her 14th Birthday in February 2009. Due to be operated on for curves of 57 and 54 degrees (S Curve) in December 2009 with Dr. Askin in Brisbane.

          Comment


          • #6
            Hi Steph, my experience with bending x-rays was certainly not as Linda Racine explained it should be. I kind of knew, from reading the posts on this forum before I went for mine, that what I had done was not quite right. All they did was ask me to bend to the right and left while I was standing and that was it. Anyway, it sounds like your surgeon wants to be sure that it is done correctly if he is sending his nurse to be sure it is.
            Dolores A
            June 4, 2009 Anterior L3 - S1
            June 8, 2009 Posterior T4 - Pelvis
            Mark Agulnick, MD FAAOS
            NY Spine & Scoliosis Center

            Comment


            • #7
              Originally posted by dolores a View Post
              Hi Steph, my experience with bending x-rays was certainly not as Linda Racine explained it should be. I kind of knew, from reading the posts on this forum before I went for mine, that what I had done was not quite right. All they did was ask me to bend to the right and left while I was standing and that was it. Anyway, it sounds like your surgeon wants to be sure that it is done correctly if he is sending his nurse to be sure it is.
              Did they xray you like that? Bending xrays are always supposed to be taken in the prone position.

              --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


              • #8
                Originally posted by LindaRacine View Post
                Did they xray you like that? Bending xrays are always supposed to be taken in the prone position.

                --Linda
                Linda, I had some done in the prone position, but I also had some standing and I remember one taken as they had me bending backward as far as I could.
                Sally
                Diagnosed with severe lumbar scoliosis at age 65.
                Posterior Fusion L2-S1 on 12/4/2007. age 67
                Anterior Fusion L3-L4,L4-L5,L5-S1 on 12/19/2007
                Additional bone removed to decompress right side of L3-L4 & L4-L5 on 4/19/2010
                New England Baptist Hospital, Boston, MA
                Dr. Frank F. Rands735.photobucket.com/albums/ww360/butterflyfive/

                "In God We Trust" Happy moments, praise God. Difficult moments, seek God. Quiet moments, worship God. Painful moments, trust God. Every moment, thank God.

                Comment


                • #9
                  Originally posted by loves to skate View Post
                  Linda, I had some done in the prone position, but I also had some standing and I remember one taken as they had me bending backward as far as I could.
                  Sally
                  Wow, never heard of that being done. Would love to hear why they needed those kinds of shots.
                  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


                  • #10
                    Yup, had bending x rays at lenox hill hospital in nyc about 4 years ago..it hurt alot to try to bend backwards! alot! xray tech said "keep bending" & i said "that is as far as i can go!"...wasnt very far at all!

                    jess

                    Comment


                    • #11
                      I didn't even have to bend backwards, just side to side while they ex-rayed me. The tech made some comment which I can't remember, but it sounded like she was unsure of the procedure.
                      Dolores A
                      June 4, 2009 Anterior L3 - S1
                      June 8, 2009 Posterior T4 - Pelvis
                      Mark Agulnick, MD FAAOS
                      NY Spine & Scoliosis Center

                      Comment


                      • #12
                        I had 2 bending xrays, both lying down. One was a push prone, where three people pushed against the curve, one at my upper ribcage, the other 2 at different levels of each hip. In the 2nd xray, I was asked to twist and contort my body myself to try and get the spine as straight as I could. That one was actually straighter than the push prone. I guess we know our curves better than anyone else. I've also hears that they sometimes use wedges positioned to try and counteract the curve as well.
                        Sandy

                        Thoracic curve was 55 degrees, now 30
                        Lumbar curve was 68 degrees, now 26
                        Rib rotation was 17 degrees, now 0
                        Degenerated discs and sacral arthritic spurs, plus significant spondylosis
                        Fused 8/13/09 at age 43 from T-9 to pelvis with iliac screws anchoring hardware to the pelvis, plus osteomies by Drs. Anthony Moreno and Geoff Cronen, Tampa, FL

                        Comment


                        • #13
                          How long before your surgery do they usually do these bending x-rays? I am seven weeks out before i have mine, and so far the only ones i have done have been from the standing position.
                          Age: 40
                          Diagnosed @ at of 11
                          Muscle Stimulator for 1 year
                          Milwaukee Brace from 1982-1987 47* (center curve)
                          (was told would never get worse)
                          Surgery November 11, 2009
                          Fused T6-T12
                          Pre Op 25* - 54* - 40*
                          Post Op 24* - 33* - 21*

                          Comment


                          • #14
                            So ... a couple of questions ...

                            I know some surgeons don't do bending films on adults. Hanson did view me while I did right and left side bends, but he said he only does the actual bending x-rays on kids. As it turned out, he estimated my correction at <=20° (based on what he saw, I assume), and that's about what I got.

                            Do other surgeons take them as a rule, or only when they suspect curve rigidity due to patient age (or maybe curve location)?

                            Do they maybe use them as an identifier for more rigid patients who might benefit from disc release?

                            I guess I'm just curious ... if it all comes down to what the body can handle in the OR (and they can only crank as far as the cycles of tension/rest will allow), what specific advantage do bending films provide?

                            Regards,
                            Pam
                            Fusion is NOT the end of the world.
                            AIDS Walk Houston 2008 5K @ 33 days post op!


                            41, dx'd JIS & Boston braced @ 10
                            Pre-op ±53°, Post-op < 20°
                            Fused 2/5/08, T4-L1 ... Darrell S. Hanson, Houston


                            VIEW MY X-RAYS
                            EMAIL ME

                            Comment


                            • #15
                              Hi Pam...

                              The doctors at UCSF routinely get bending xrays on preop patients. I'm not sure about other centers.

                              According to the Spinal Deformity Study Group Radiographic Measurement Manual, bending xrays are optional.

                              By the way, I know I owe you an email. I need to get some info and will answer soon.

                              Loris, my bending xrays were taken a few days before my surgery.

                              Regards,
                              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

                              Working...
                              X