Page 1 of 2 12 LastLast
Results 1 to 15 of 20

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

  1. #1
    Join Date
    Jan 2012
    Location
    Yacolt, WA
    Posts
    1,525

    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 Degenerative Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Severe disc degen T & L stenosis

    2013: T3- S1 Fusion w/ ALIF L4-S1/XLIF L2-4, PSF T4-S1 in 2 surgeries
    2014: Hernia @ ALIF repaired; Emergency screw removal surgery for Spinal Cord Injury at T4,5 sec to PJK
    2015: Revision 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 + prayer

  2. #2
    Join Date
    May 2008
    Location
    reno,nevada
    Posts
    3,535
    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 58, the new 53...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF 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

  3. #3
    Join Date
    Jan 2012
    Location
    Yacolt, WA
    Posts
    1,525
    Quote 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 Degenerative Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Severe disc degen T & L stenosis

    2013: T3- S1 Fusion w/ ALIF L4-S1/XLIF L2-4, PSF T4-S1 in 2 surgeries
    2014: Hernia @ ALIF repaired; Emergency screw removal surgery for Spinal Cord Injury at T4,5 sec to PJK
    2015: Revision 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 + prayer

  4. #4
    Join Date
    May 2009
    Posts
    3,745
    susan, question....did your curves increase in size?
    i thought that was one of the concerns you mentioned
    before you saw the doctor...???????

    jess

  5. #5
    Join Date
    May 2009
    Posts
    3,745
    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

  6. #6
    Join Date
    Aug 2011
    Location
    Wales
    Posts
    248
    Quote 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...

  7. #7
    Join Date
    May 2008
    Location
    reno,nevada
    Posts
    3,535
    Quote 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 58, the new 53...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF 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

  8. #8
    Join Date
    May 2009
    Posts
    3,745
    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

  9. #9
    Join Date
    May 2008
    Location
    reno,nevada
    Posts
    3,535
    Quote Originally Posted by susancook View Post
    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
    49 yr old male, now 58, the new 53...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF 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

  10. #10
    Join Date
    Jan 2012
    Location
    Yacolt, WA
    Posts
    1,525
    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 Degenerative Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Severe disc degen T & L stenosis

    2013: T3- S1 Fusion w/ ALIF L4-S1/XLIF L2-4, PSF T4-S1 in 2 surgeries
    2014: Hernia @ ALIF repaired; Emergency screw removal surgery for Spinal Cord Injury at T4,5 sec to PJK
    2015: Revision 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 + prayer

  11. #11
    Join Date
    Jan 2012
    Location
    Yacolt, WA
    Posts
    1,525
    Quote 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 Degenerative Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Severe disc degen T & L stenosis

    2013: T3- S1 Fusion w/ ALIF L4-S1/XLIF L2-4, PSF T4-S1 in 2 surgeries
    2014: Hernia @ ALIF repaired; Emergency screw removal surgery for Spinal Cord Injury at T4,5 sec to PJK
    2015: Revision 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 + prayer

  12. #12
    Join Date
    Sep 2003
    Location
    Northern California
    Posts
    6,797
    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. --Dilbert
    I'm sarcastic... what's your super power? --Unknown
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    If you've signed up and are having trouble posting, please check your spam folder. An email was sent to the email address which you subscribed. You have to follow the instructions in that email. Done that and still having trouble posting? Contact Joe O'Brien at jpobrien@scoliosis.org.

  13. #13
    Join Date
    Jan 2012
    Location
    Yacolt, WA
    Posts
    1,525

    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 Degenerative Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Severe disc degen T & L stenosis

    2013: T3- S1 Fusion w/ ALIF L4-S1/XLIF L2-4, PSF T4-S1 in 2 surgeries
    2014: Hernia @ ALIF repaired; Emergency screw removal surgery for Spinal Cord Injury at T4,5 sec to PJK
    2015: Revision 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 + prayer

  14. #14
    Join Date
    Jan 2008
    Location
    NC
    Posts
    8,901
    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 at 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."

  15. #15
    Join Date
    Sep 2003
    Location
    Northern California
    Posts
    6,797
    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. --Dilbert
    I'm sarcastic... what's your super power? --Unknown
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    If you've signed up and are having trouble posting, please check your spam folder. An email was sent to the email address which you subscribed. You have to follow the instructions in that email. Done that and still having trouble posting? Contact Joe O'Brien at jpobrien@scoliosis.org.

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •