Not my second daugther too

[titaniumed]

Thanks Ed, with her many respiratory issues she had to work extra hard to catch-up and keep-up with her assignments.

My youngest is going to attend UCSC and my oldest wants to attend UCLA after taking a gap year. Santa Cruz is relatively close to San Francisco so I am trying to figure out where to take her for her back pain. --Any ideas?

A Mom

For Santa Cruz, Stanford and or USCF. Both have scoliosis teams. Both are excellent places.

Its important that scoliosis patients are evaluated by scoliosis surgeons. Scoliosis surgeons are the only ones trained in "balancing" spines which is important in spine deformity. Take all diagnostic and records with you.

Has your elder daughter with the large lordosis been evaluated by a scoliosis surgeon? I remember seeing her x-ray at some point here, and if its a 90, I wouldn't ignore that since these large curves can progress at a faster rate..... For the LA area, Dr Pashman would be a good start.
http://espine.com/

Having good insurance is a must....This should always be addressed before going in.

Linda posted the Stanford page, here is the UCSF page
https://www.ucsfhealth.org/treatment...sis/index.html

Get all diagnostics burned to disc in "your" possession. These are important records for the future should they move to another state and need surgery in the future. I have all my old records. I have x-rays that date back to the 1980's. I have my CT's and MRI's on disc.

Once again, surgery is always a last ditch effort....and the more difficult cases take a lot of thought.... There is never any rush on surgery, so non-surgical attempts will be tried first.

Ed

[LindaRacine]

Thanks Ed, with her many respiratory issues she had to work extra hard to catch-up and keep-up with her assignments.

My youngest is going to attend UCSC and my oldest wants to attend UCLA after taking a gap year. Santa Cruz is relatively close to San Francisco so I am trying to figure out where to take her for her back pain. --Any ideas?

A Mom

The closest specialists to Santa Cruz are at Stanford.

https://stanfordhealthcare.org/searc...re_phy&q1=true

[AMom]

Hi Sharon,

Actually, Santa Cruz only allows a provisional choice of major. She is interested in history, with a focus on American history. She thinks she might want to teach high school history, however she is also interested in Social Work. After a year or two at college, she may change her mind again (or many, many times!) She is good with people in general and kids of all ages love her; children gravitate to her.

A Mom

[AMom]

Thanks Ed, with her many respiratory issues she had to work extra hard to catch-up and keep-up with her assignments.

My youngest is going to attend UCSC and my oldest wants to attend UCLA after taking a gap year. Santa Cruz is relatively close to San Francisco so I am trying to figure out where to take her for her back pain. --Any ideas?

A Mom

[Pooka1]

AMom congratulations to your daughter on doing a great job! Has she decided on a major yet? Some schools here make you choose before your go which is really odd in my opinion.

[titaniumed]

Hi AMom, Congratulations to your daughter on the graduation and the good grades! Woo-hoo!

Does she know where she wants to go to school?

And, where are you in California? Being close to a scoliosis center is a bonus....

Ed

[AMom]

lordosis, chronic back pain, ortho

My youngest daughter just graduated from high school, yea!
She earned her letter in academics.
She is a NHS recipient.
She earned her Gold Award (a year long leadership and community service project)
She has been accepted to the UC system.

She has been complaining about her back and neck pain since she was a little girl and is now asking to see an ortho for her lordosis issues to see if they can "fix" her back.

Does anyone have recommendations for orthos who work with this issue? Curve was last measured at 85 degrees. We live in California.

AMom

[LindaRacine]

FYI: My daughters prefer the EOS to standard x-rays. It was quiet, quick (seemed quicker than x-rays), painless, and they did not worry as much about radiation. There was no need for multiple x-rays in an effort to stitch together an image of the entire spine.

Thank you for sharing that article!

"Vertebral osteoporosis

EOS® imaging was also tested for the study of vertebral osteoporosis. It was first compared to dual-energy X-ray absorptiometry (DXA) using a Hologic® device for measurement of bone mineral density (BMD) [35]. Both techniques were used to determine BMD on the European Spine Phantom, and the results were compared to the values given by the manufacturer of the phantom. EOS® imaging was more accurate than Hologic® (5.2 % compared to 7.2 %) and had very good reproducibility [35]. In another study, it was used to determine the BMDs of 14 fresh-frozen vertebrae, as well as to provide a 3D reconstruction of these vertebrae [36]. Thus, a subject-specific finite element model (FEM) of each vertebra was created, which led to better prediction of the failure load of these vertebrae.

What do we do now? Who would we send the EOS to to check her bone density level?

A Mom

I would probably start with the radiology report and/or the radiologist where the images were taken.

[AMom]

what test is used to determine bone density?

FYI: My daughters prefer the EOS to standard x-rays. It was quiet, quick (seemed quicker than x-rays), painless, and they did not worry as much about radiation. There was no need for multiple x-rays in an effort to stitch together an image of the entire spine.

Thank you for sharing that article!

"Vertebral osteoporosis

EOS® imaging was also tested for the study of vertebral osteoporosis. It was first compared to dual-energy X-ray absorptiometry (DXA) using a Hologic® device for measurement of bone mineral density (BMD) [35]. Both techniques were used to determine BMD on the European Spine Phantom, and the results were compared to the values given by the manufacturer of the phantom. EOS® imaging was more accurate than Hologic® (5.2 % compared to 7.2 %) and had very good reproducibility [35]. In another study, it was used to determine the BMDs of 14 fresh-frozen vertebrae, as well as to provide a 3D reconstruction of these vertebrae [36]. Thus, a subject-specific finite element model (FEM) of each vertebra was created, which led to better prediction of the failure load of these vertebrae.

What do we do now? Who would we send the EOS to to check her bone density level?

A Mom

[LindaRacine]

Yet another doctor's visit. I should buy stock in the medical profession to try and break even.

Linda, would an EOS show bone density or does she have to have a different type of scan? I ask because the pulmonologist told us she needed a bone density scan to see what/ if any damage has occurred due to years of steroid use. Of course she said we need to take her to the PCP to order the test.

I didn't know this*, but did a search, and it appears that EOS films can be used to correlate a value for bone mineral density.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4763151/

*We don't have enough space for the EOS system in our current location. We're being moved to a new floor next year, and we'll be switching to EOS at that time.

[AMom]

what test is used to determine bone density

Yet another doctor's visit. I should buy stock in the medical profession to try and break even.

Linda, would an EOS show bone density or does she have to have a different type of scan? I ask because the pulmonologist told us she needed a bone density scan to see what/ if any damage has occurred due to years of steroid use. Of course she said we need to take her to the PCP to order the test.

[titaniumed]

I would suspect that they will lead the physical therapists and be involved in creating some sort of exercise and stretching program......These large lordosis cases are not all that common, (or at least on this forum) it will be interesting to see how they handle it. Exercises and stretches are good things, they keep our minds occupied, and they also have a few tricks with hot and cold therapies, ultrasound etc that they will probably try. Learning what to do, and not to do, and setting the patient on course....Physical therapy can only help. It’s a positive thing.

I loved it so much that I had my shoulder surgeon extend my prescription.

Do post and let us know how it all turns out. (smiley face)

Ed

[AMom]

Physiatrist

This is good news A-mom..... thanks for the fantastic post!

I get a kick out of the low grade, high grade designation on spondy’s. Some of the spondylolisthesis x-rays can be quite alarming......I am sure you have seen them, and will keep an eye out for this in the future....

Seeing a Physiatrist sounds like a good idea...

Ed

Hi Ed,

Absolutely agree, those x-rays are alarming. I hope we never see them on my daughter's images!

I talked to her about everything and she said that she would like to get some help with her back pain because it hurts every day. Do you have any idea of what we can expect from a physiatrist?

A Mom

[titaniumed]

This is good news A-mom..... thanks for the fantastic post!

I get a kick out of the low grade, high grade designation on spondy’s. Some of the spondylolisthesis x-rays can be quite alarming......I am sure you have seen them, and will keep an eye out for this in the future....

Seeing a Physiatrist sounds like a good idea...

Ed

[AMom]

lordosis is appropriate for her sacral slope

Hi All,

I forwarded my youngest daughter’s latest EOS scan, photos, and pain diagrams for review recently and received a reply. Her degree of lordosis (85°) is appropriate for the degree of her sacral slope (85°); meaning the matching curves keeps her standing upright. Also, her EOS does not show any spinal abnormalities therefore the cause of her pain is not readily apparent. Yea, no need for surgery!

If her pain persists, we might want to take her to a physiatrist.

With her sacral slope, she may end up with spondylolisthesis; however, it is not an issue at this time.

For those of us who do not have a medical degree (or experience in this area) I included simple explanations of various terms below.

A Mom

What is EOS?
The EOS Imaging System is a low-dose, 3-D imaging system that scans your child standing up. An EOS scan shows us your child’s natural, weight-bearing posture and allows us to see the interaction between the joints and the rest of the musculoskeletal system, particularly the spine, hips and legs.

EOS imaging uses an ultra-low dose of radiation to provide extremely detailed, high-quality images. It uses a significantly lower radiation dose than a general radiography x-ray. With EOS scans, we can make more informed diagnoses and create individualized treatment plans for children with musculoskeletal disorders.
From: http://www.chop.edu/treatments/eos-x-ray-imaging-system

10
Analysis of the Dynamic Sagittal Balance of
the Lumbo-Pelvi-Femoral Complex
Legaye Jean
University of Louvain, Mont-Godinne
Belgium

These correlations allowed establishing the essential role of the pelvic morphology in the
regulation of the sagittal spinal curves: high value of “Pelvic Incidence” was associated to
high “Sacral Slope” value and an important “Lordosis” (Figure 5 A), low “Pelvic Incidence”
value was associated with low “Sacral Slope” value and a more flat “Lordosis”. (Figure 5 B)

Image: see link and look at page 227

Fig. 5. Low (A.) and great (B.) value of “Pelvic Incidence” and sagittal lumbar shape.
The normality of a sagittal shape was attested by the harmony of these relationships, and
not by comparing observed and average values. Using these equations, it became possible to
assess the “Sacral Slope” adapted to the individual value of “Pelvic Incidence”. The
difference between the observed and this optimal value was named “ΔPS”. Similarly, the
value of “Lordosis” adapted to the observed “Sacral Slope” was determinable (the
difference between observed and calculated value was named “Δlord”) and even the
optimal value of “Lordosis” according to the “Sacral Slope” adapted by the “Pelvic
Incidence” (the difference with the observed value was named “Δlord optimal”). This
analytic evaluation allowed detecting a global or a local disturbance (pelvic, lumbar,
kyphotic …). A pelvic tilt was considered significant if “ΔPS” exceeded 12 °, lordosis was
unsuited to the observed sacral slope if “Δlord” was more than 8 ° or unsuited to the pelvic
incidence if “Δlord optimal” was more than 8 °.
From: http://cdn.intechopen.com/pdfs-wm/19659.pdf

What is a Physiatrist?
Physical Medicine and Rehabilitation (PM&R) physicians, also known as physiatrists, treat a wide variety of medical conditions affecting the brain, spinal cord, nerves, bones, joints, ligaments, muscles, and tendons.

PM&R physicians are medical doctors who have completed training in the specialty of Physical Medicine and Rehabilitation (PM&R), and may be subspecialty certified in Brain Injury Medicine, Hospice and Palliative Medicine, Neuromuscular Medicine, Pain Medicine, Pediatric Rehabilitation Medicine, Spinal Cord Injury Medicine, and/or Sports Medicine.

Specifically, PM&R physicians:
• Treat patients of all ages
• Focus treatment on function
• Have a broad medical expertise that allows them to treat disabling conditions throughout a person’s lifetime
• Diagnose and treat pain as a result of an injury, illness, or disabling condition
• Determine and lead a treatment/prevention plan
• Lead a team of medical professionals, which may include physical therapists, occupational therapists, and physician extenders to optimize patient care
• Work with other physicians, which may include primary care physicians, neurologists, orthopedic surgeons, and many others.
• Treat the whole person, not just the problem area
From: https://www.aapmr.org/about-physiatr...t-is-physiatry

Spondylolisthesis
If left untreated, spondylolysis can weaken the vertebra so much that it is unable to maintain its proper position in the spine. This condition is called spondylolisthesis.

In spondylolisthesis, the fractured pars interarticularis separates, allowing the injured vertebra to shift or slip forward on the vertebra directly below it. In children and adolescents, this slippage most often occurs during periods of rapid growth—such as an adolescent growth spurt.

Doctors commonly describe spondylolisthesis as either low grade or high grade, depending upon the amount of slippage. A high-grade slip occurs when more than 50 percent of the width of the fractured vertebra slips forward on the vertebra below it. Patients with high-grade slips are more likely to experience significant pain and nerve injury and to need surgery to relieve their symptoms.

image: see link & scroll down the page

(Left) The pars interarticularis is a narrow bridge of bone found in the back portion of the vertebra. (Center) Spondylolysis occurs when there is a fracture of the pars interarticularis. (Right) Spondylolisthesis occurs when the vertebra shifts forward due to instability from the pars fracture.
From: http://orthoinfo.aaos.org/topic.cfm?topic=a00053