Sending X-rays safely

[jillw]

For those who know, how do they do a bending xray anyway? Are you standing and bending sideways opposite the curve? Are you laying on your stomach bending up (or is that considered a laying down curve)? Something I've wondered about....With Katie they did an xray where she was on her stomach and bending up to see her flexibility (don't know what that kind of xray is called) and her curve did not reduce significantly which meant her spine was less flexible than I had expected for a barely 7 year old who is double jointed and very flexible in all other areas of her body! I guess you can never tell.

Regarding the lateral xray, I think they are looking to see if there is evidence of hyperkyphosis which would contraindicate VBS. Janet had mentioned that it is not uncommon for scoliosis to be associated with hypOkyphosis so for many it is not an issue (hyperkyphosis being too big of a front to back curve whereas hypokyphosis would be smaller than normal...i don't know what the range of "normal" kyphosis is for a person, though.

I hope you are keeping a good list of all your questions to ask the experts when you speak to them (I'd love to hear what they have to say)

[mariaf]

Sharon,

Great post(s) - I agree that SOME, not all, of bracing failures are due to non-compliance.

Jill,

Are you sure you're not an engineer?? LOL!!

What you wrote made tons of sense and is in line with my understanding as well. I wanted to add that out of all the staples inserted (I don't have the number in front of me but I've seen it and it's in the thousands), only a few broke or had any problems. Also, let's say, if later in life a staple were to crack BUT both ends were solidly in bone they would probably just leave it alone.

That being said, of course as you mention with ANY human hardward you have to be prepared for the fact that it may not last a lifetime. I think that's one of the few downsides to VBS. However, if it's a choice of VBS vs. fusion then you're dealing with hardware either way and I agree with what you wrote about a small device like a staple "giving" much more than one long, stiff, solid rod. Also, there are issues with rigid bracing too (muscle atrophy, the effect on lung development in younger kids, social issues, etc.)

Which is why the bottom line is that treatment for scoliosis is not a "one size fits all" decision. It's a personal one to be made after speaking to doctors, educating one's self - something the parents on this forum all seem to do extremely well. It amazes me how much folks must often learn in a very short time before having to make a heart-wrenching decision.

Keep up the good work - and my best wishes to all.

[WNCmom]

Question:

Is a bending x-ray taken from the back with the patient bending sideways (against the curve to show spinal flexibility), or with the patient bending forward? Or is it something else altogether? I'm still not clear.

[mariaf]

WNCmom,

When they did a bending x-ray on my son he was actually lying (on his back I believe) on a table. then they made him into a "C", bringing his head and feet over to one side - AGAINST the curve to see how much it would straighten.

Hope that makes sense.

[sccrm08]

When they did my bending x-rays, the first time I was standing and they had me bend to each side. These did not show a whole lot of correction, so the surgeon sent me back for another set. The second time they had me lie on the floor and bend to each side. These showed a much better correction. I hope this helps.

[txmarinemom]

Bending films ...

Bending films can be taken either standing or supine (lying down, on the back).

Although they're often taken to estimate correction after fusion (as the patient bends against the curve), they're just as often used to determine structural vs. compensatory curves.

For example, it looked like my back had *3* distinct curves (cervical, thoracic and lumbar). As is often the case, I only had a single, right structural thoracic curve.

The cervical and lumbar curves were simply compensatory curves my body developed to balance itself from the 53° thoracic curve (the compensatories were never even measured).

Structural curves are defined as those curves that incompletely straighten on side-bending. Compensatory curves straighten significantly (sometimes completely) on side bending and function to produce spinal balance.

Additionally, supine bending films generally show a greater correction on bending out than bending films taken while the patient is standing.

Regards,
Pam

[txmarinemom]

I agree that SOME, not all, of bracing failures are due to non-compliance.

In my case, I would have to agree with SOME *don't*.

My scoli was discovered at age 10. After thorough discussion, Hanson and I agreed I was most likely Juvenile Ideopathic vs. AIS simply because at 10, my curve was already 30-35° (I can't get my films - they've been destroyed).

It stands to reason my curve had started to develop *before* age 10.

There's a VERY good chance NO bracing would have had equal effect on my curve: I was extremely non-compliant (I played sports, so I'd leave the house every morning ... get to school, and toss my brace in my Athletics locker).

Even though I rarely wore my brace, by age 20 or so it had only progressed to ±50° (Cobb ranged from 48-53°). I watched it throughout adulthood, and even with the general concensus a curve of ±50° can be expected to move at ±1° per year in adulthood, mine remained stable.

As many of you know, I only had surgery because 30 years of pain had turned into *increasing* pain - and I personally felt having surgery at 39 was a more prudent option for me vs. surgery at 49 or 59.

I'll never know for sure whether regular wear would have held my curve, but I do know, I had incredible back pain by the time I was 10. Even if my curve had been 40°, I very likely would have had fusion *anyway* in a last attempt at pain relief.

(Remember, I'd already tried everything else possible ... surgery was NOT my first choice)

That said, Hanson gave me a 70% estimate of significant pain relief, 30% of no change, and almost no chance of worsened pain. Knowing the risks, the possible complications, the new pain that could result from surgery, etc., I choose surgery because I felt those odds were too good to pass up.

I'm so glad I took that shot. It's impossible (even through all the normal post fusion soreness) to describe waking up and immediately crying to my Mom ... "It's GONE ... OMG, it's GONE!!"

(The first few days - as I developed more soreness from the surgery - I did have to wonder if it wasn't just a case of "let me smash your foot so you don't notice that hangnail - LOL!)

Outside the birth of my children, the realization it was truly banished after almost my entire lifetime, rates as the 2nd most miraculous moment of my life (and I'm still SO grateful for it every day).

My unwanted companion of 30 years is finally, literally off my back!

[WNCmom]

Thanks, everyone, for your descriptions of how bending x-rays are done.