Muscular question to Dr. McIntire

[flerc]

People have tried many many things to measure on the outside in order to reduce the number of x-rays and monitor curve progression. But nothing has really become too popular.

I believe that apofisis move toward the concave side of the curve, so I think that if we paint it, like this Dr. recommends to do (for other issues),http://www.santonjatrauma.es/documen...ratamiento.pdf we'll can see a curve that should to be less than the actual curve seen in the x-ray. This difference should to tell us about rotation. For instance, if we are adults and curve is not improving (our height is not growing), if that painted curve is decreasing, rotation is increasing.

[flerc]

Yes, it seems that should to exist limits, otherwise somebody without a curve, could has a big rotation and it sounds impossible. But I know about 2 cases of adults with 45°, who are decided to surgery because, even the curve are not growing (at least no so much), they think that rotation is so big that organs are affected and it would grow much more and lungs will not resist. I have read several times that it could only happen with curves over 80 or 90°. It is really something serious if they are mistaken.

[skevimc]

Does not exist any limit ? A curve of 45º could have more rotation than other of 90º? If it is true, scoliosis could be mortal with not so much degrees.

I'm sure there is some relationship. What I meant by that was that assuming there was a way to measure rotation without an x-ray, you wouldn't be able to say 10° of rotation means they have a 30-35° curve. People have tried many many things to measure on the outside in order to reduce the number of x-rays and monitor curve progression. But nothing has really become too popular. And one reason is because each curve will have different amounts of rotation, rib deformity and other such measurements. So, they are related in that they accompany each other. But they are separate in that they seem to form differently for each curve.

[Pooka1]

Does not exist any limit ? A curve of 45º could have more rotation than other of 90º? If it is true, scoliosis could be mortal with not so much degrees.

Apparently there are limits. Look at the paper I posted in Post # 30 in this thread.

I agree it makes sense that there are some limits although the limits in that publication may just be what is observed, not what is possible.

[flerc]

As Pooka mentioned, vertebral rotation does not correlate with cobb angle.

Does not exist any limit ? A curve of 45º could have more rotation than other of 90º? If it is true, scoliosis could be mortal with not so much degrees.

[skevimc]

If true, and also considering my two "test" subjects, the Adams bending test is as a matter of fact measuring some combination of rotation and lateral curve and NOT just or even mainly rotation irrespective of what any/book report claims.

Probably measuring all of the above. Clearly influenced by many things.

[flerc]

I’m very close to be absolutely sure that this muscles involved in rotation are the guilty ones http://www.scoliosis.org/forum/showt...ht=guilty+ones
But in fact I’m not very sure about what could happen with the proof of the twins.
The twin without scoliosis while she is anesthetized, she would remains with her spine straight, but it would be because her vertebras are all embedded in the right way, without rotation. But what could happens if we move her trunk trying to rotate it?
I’m not very sure that a lateral curve will appears.
What do you think?

[Pooka1]

So the test is measuring primarily the apparent rotation of the vertebrae via rib deformity. But there have been several studies showing that the false-positive rate for the Adams makes it slightly less reliable. One of my adult validation test subjects had a positive Adams test. We went on to get an x-ray and they were perfectly straight. The positive test was a result of increased back musculature.

That girl with the hysterical case (60* down to 15* in a few weeks I think) that we were discussing claimed I think in her youtube video comments to have a positive reading on the Adams forward bending test and yet she had no (or little) rotation.

Here's a thread with a bunch of bunnies discussing this case...
http://www.scoliosis.org/forum/showt...nth&highlight=

If true, and also considering my two "test" subjects, the Adams bending test is as a matter of fact measuring some combination of rotation and lateral curve and NOT just or even mainly rotation irrespective of what any/book report claims.

[Ballet Mom]

A question remains if the rotation can remain apart from the lateral curve. That is, as the lateral curve decreases, can the rotation aspect remain. I think not or at least it would be undetectable except on radiological imaging.

Another question is what exactly in the Adams bending test measuring... mostly lateral curve, mostly rotation, equal amalgam of both, etc. etc.?

As I recall in the case of my girls who had large curves but very different degrees of rotation UPON VISUAL INSPECTION (not talking radiologically here), they both had very large slopes when bent over. So my guess is the Adams test largely reflects lateral curve and NOT rotation per se.

How about vertebral rotation without lateral angulation? Scroll down to figures 4 and 5 at the link. So the forward bend test is measuring rotation.

http://www.scoliosis-australia.org/s...gist_role.html

There is one variant of AIS which is most often seen in siblings of patients with AIS. It is viewed as the mildest expression of the deformity where the spine rotates in its long axis, but coronal plane deformity does not develop. The asymmetrical pedicle shadows and deviated spinous processes are diagnostic of this change which is of no clinical significance, even though the FBT (forward bend test) is positive (Figures 4 and 5 ).

And then there's my daughter whose rotation pretty much disappeared even though she had a very noticeable twist across the middle of her back and her curves didn't change size during that time. (Although I think this is very unusual). Her surgeon runs that scoliometer up and down her spine, over and over again trying to get a measurement, lol. I find it hard to believe her curve could be removed with anesthesia, although I'd love to give it a try and hope that it would! I'm sure it wasn't hysteria that caused it though.

[skevimc]

A question remains if the rotation can remain apart from the lateral curve. That is, as the lateral curve decreases, can the rotation aspect remain. I think not or at least it would be undetectable except on radiological imaging.

I would agree with you. I think if there is reduction in the lateral curve then the rotational aspect would also improve. But at the same time, I think these are also very separate components and would depend a lot on the starting size.

Another question is what exactly in the Adams bending test measuring... mostly lateral curve, mostly rotation, equal amalgam of both, etc. etc.?

As I recall in the case of my girls who had large curves but very different degrees of rotation UPON VISUAL INSPECTION (not talking radiologically here), they both had very large slopes when bent over. So my guess is the Adams test largely reflects lateral curve and NOT rotation per se.

From the article that developed the scoliometer

One of the constant features of a structural scoliosis is the axial notation of the vertebrae that are involved in the curve. The spinous processes always rotate toward the concavity of the curvature, as seen on a radiograph. Rotation of thoracic vertebrae causes rotation and deformity of the attached rib cage, with elevation on the side of the convexity and depression on the side of the concavity. This asymmetry is significantly accentuated by having the patient bend forward; examination of the patient in the forward-bent position is the standard method that is taught for detecting a mild degree of curvature in mass screening examinations.

So the test is measuring primarily the apparent rotation of the vertebrae via rib deformity. But there have been several studies showing that the false-positive rate for the Adams makes it slightly less reliable. One of my adult validation test subjects had a positive Adams test. We went on to get an x-ray and they were perfectly straight. The positive test was a result of increased back musculature.

[Pooka1]

As Pooka mentioned, vertebral rotation does not correlate with cobb angle. However, all adolescent idiopathic scoliosis (AIS) have vertebral rotation. There are some cases of scoliosis that do not have rotation and these aren't diagnosed as AIS and I think usually have a neurological cause or some other type of deformity.

The scolioses without rotation would seem to include the exquisitely rare hysterical form wherein folks can literally be talked out of their curve. Also, this hysterical curve type may disappear simply by putting someone under anesthaesia as has been discussed.

A question remains if the rotation can remain apart from the lateral curve. That is, as the lateral curve decreases, can the rotation aspect remain. I think not or at least it would be undetectable except on radiological imaging.

Another question is what exactly in the Adams bending test measuring... mostly lateral curve, mostly rotation, equal amalgam of both, etc. etc.?

As I recall in the case of my girls who had large curves but very different degrees of rotation UPON VISUAL INSPECTION (not talking radiologically here), they both had very large slopes when bent over. So my guess is the Adams test largely reflects lateral curve and NOT rotation per se.

[skevimc]

Seems like most of the people in this group are WAY more intelligent that I am. I don't have an engineer's mind!! LOL. No, it really doesn't make sense.

No this is not a matter of intelligence. It is rather a matter of specific knowledge. Completely different.

What she said.

Do all kids with scoliosis have rotation? Our doctor has never mentioned it. I've never heard the word until joining this group. My daughter right should blade sticks out further than her left and when she bends over, her right side is further up than her left side. Does that mean her spine has rotated? She has a 36 degree thoracic curve and currently has worn a Boston brace for 3 years. Her curve recently progressed from 27 degrees to 36 degrees. I've been looking into exercises or even the VBS, so I'm trying to get information about everything I can. She's 14 and still growing.

Thanks for your help!!

As Pooka mentioned, vertebral rotation does not correlate with cobb angle. However, all adolescent idiopathic scoliosis (AIS) have vertebral rotation. There are some cases of scoliosis that do not have rotation and these aren't diagnosed as AIS and I think usually have a neurological cause or some other type of deformity.

Click this link and the article has a good picture of what we're talking about. Scroll down a bit to see the pictures.

http://ittcs.wordpress.com/2010/05/2...-of-the-spine/

The elevated side you mention with your daughter when she bends over is called the rib hump and is related to the amount vertebral rotation. However, it does not say exactly how much rotation because the hump is caused by the ribs which are attached to the vertebrae. Some doctors measure it and some don't.

It doesn't seem like you are, but don't be scared to ask these types of questions. Even if you don't/didn't know what a vertebrae is. Ask. There's nothing wrong with not knowing something. You can also send a private message to me, or probably most of the other frequent fliers on here. I'm always happy to help.

[foofer]

For sure disc decompression happens. It would only be a guess about how much and what effect that would have. I know that horizontal x-rays are different than vertical x-rays with the horizontally measured curves being smaller. So it would stand to reason that a complete inversion would reduce it at least that much if not more because of the added traction. It would be an interesting thing to look at and would be pretty easy to role an inversion table into an x-ray room.

I wonder if it's ever been done in any way, and documented. If it did straighten curves, we would all have to learn to walk on our hands. When inverted, it really does feel like space is being created for discs, and the day's compression- the squish factor, seems to shake out....unfortunately, I have to come out of it and then can feel the opposite again- it all slowly thunks back together and towards earth again.

Maybe torso rotation on an inversion table? I like to do what I understand to be "side-shifting" in the inverted position. I have a double structural, so it involves easing to the right, away from left lumbar curve, then easing to the left away from the right thoracic- at the same time breathing into the left thoracic area and also pressing small of back into the table, as I have too much lordosis. When I get it all going at once, choirs of angels float in front of my eyes. Disclaimer: This is just something that feels "right" to me- not anything prescribed by a doctor, PT- just my own new-fangled tinkering. As I've said before, I'm on the "if it feels good, do it" PT plan.

[Pooka1]

Here's a paper from 1969 explaining how rotation is measured.

It is notable because there are physical bounds on rotation given the Cobb (see table 1) which is not so surprising.

http://www.ejbjs.org/cgi/reprint/51/2/223

With my daughters, one had a huge rotation and the other barely so at similar Cobb angles. So there is definitely a range in rotation for a given Cobb angle.

[Pooka1]

Seems like most of the people in this group are WAY more intelligent that I am. I don't have an engineer's mind!! LOL. No, it really doesn't make sense. Do all kids with scoliosis have rotation? Our doctor has never mentioned it. I've never heard the word until joining this group. My daughter right should blade sticks out further than her left and when she bends over, her right side is further up than her left side. Does that mean her spine has rotated? She has a 36 degree thoracic curve and currently has worn a Boston brace for 3 years. Her curve recently progressed from 27 degrees to 36 degrees. I've been looking into exercises or even the VBS, so I'm trying to get information about everything I can. She's 14 and still growing.

Thanks for your help!!

No this is not a matter of intelligence. It is rather a matter of specific knowledge. Completely different.

The spine can be abnormal in these planes:

1. front-back - this is the normal Cobb angle plane. Any angle >10* is scoliosis.
2. side-side - this is the sagittal plane and is whether the spine is bent too far forward or too far back.
3. Transverse - looking straight down on the spine. In a normal person, the vertebrae are not rotated with respect to one another in this plane. If they are rotated as in a scoliosis, they will be rotated in the direction of the convexity again looking straight down from the top of the spine.

In re rotation in specific cases, it is not a lock-step thing with Cobb angle as far as I know. Thus you can have a 40* curve with a little or a lot of rotation.

Also there is the Adam's forward bending test which I think measures some amalgam of both curve magnitude and rotation but I don't know that. Our surgeon never once measured the slope of my daughters' back on the forward bending test so I assume it is both not relevant to the treatment and is not relevant to surgical correction like say determining the lowest instrumented vertebrae is.