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Thread: X-ray help: Are these atypical features or just artifacts?

  1. #1
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    X-ray help: Are these atypical features or just artifacts?

    Hello! This is my first post here, please forgive the long post. It's been 2 years since I've seen my doctor, and I've been analyzing my x-rays these last few weeks and I noticed some things that I wasn't sure if they are unusual. For reference, I'm 19 years old, male, and have a 56-degree thoracic curve and 32-degree lumbar curve, and currently 23 degrees of rib hump/ATR.

    My first question:

    The coronal-plane outline of my ribcage seems to mildly follow the shape of my spinal curve on the concave side.
    coronal_xray.jpg

    I have seen other x-rays where the convex-side ribcage outline follows the shape of the spinal curve by bulging outwards in the middle, but I haven't seen any x-rays where the concave side ribcage outline dips in and out like mine does. (EDIT: My family and I believe this feature is an illusion from the rotation of my ribcage, but then why haven't I seen this more frequently in other x-rays, since all scoliosis has rotation?) I was hoping someone with more experience could clarify whether this is just some measurement artifact or just a postural thing? It happens to be a place where I feel pain (when I sneeze, go on an inversion table, or come up from bending over), so I'm not sure if that's connected, I've been told I'm not supposed to feel any pain from my scoliosis and I wasn't sure if maybe this is the reason for my pain.

    My 2nd question, relating to this x-ray and MRI: mri_vs_xray.jpg

    Is it unusual that the top half of my thoracic curve is significantly more curved than the bottom half of my thoracic curve?

    My 3rd question, also to the above picture: Is it weird that the curve size on my MRI seems similar or at least not much smaller than on my x-ray. I heard supine x-rays were supposed to be 60% of standing, but by eyeballing it and also measuring it using the built-in cobb angle tool, it really doesn't look more than a couple degrees smaller than standing if even that (although my lumbar curve does look much smaller, from what I could tell it corrects to around 2/3 of what it is on x-ray).

    My 4th question, is: I heard not having hypokyphosis is unusual with adolescent scoliosis, is this true? Because it seems like I do not have hypokyphosis, if anything I might have hyperkyphosis on my sagittal x-ray but I can't tell for sure, I outlined my vertebrae shapes in red in this x-ray so they are more visible: sagittal_xray.jpg


    Final Questions about sagittal alignment and cervicothoracic curvature:

    From the sagittal x-ray I just posted above, I thought my kyphosis looked a little weird because it wasn't a long/smooth curve like the other hyperkyphosis x-rays I looked at. I zoomed in a lot on the T5-T8 segment and I found a vertebrae that looked strange, it happens to be T7, the apical vertebrae of my scoliosis as well: T7_zoomin.jpg


    It seems to be longer in the back than in the front. I looked over my other vertebrae and it is the only one that has this shape in the sagittal x-ray. Is it unusual to have a single posteriorly wedged vertebrae? I looked back at my x-ray from when I was 12, and I could not find any posterior wedging of T7 on that x-ray, so it's not congenital.

    Further, is it even posteriorly wedged at all? Could it be some sort of error/illusion from my rotation? Yet thinking about it some more, doesn't all scoliosis have rotation, and if so, then wouldn't this posterior wedging be a common feature in every scoliosis x-ray?

    The reason I wonder whether it's an illusion is because, on my MRI, I zoomed in on the same T5-T8 segment and it seemed like my sagittal alignment was totally different!
    T5-T8 segment on MRI: t7s.jpg

    No posterior wedging when the MRI is centered on T7, and very little kyphosis too.

    Also, the sagittal ribcage outline of my MRI is pretty straight, doesn't seem to be kyphotic, here's a screenshot to show you what I mean: https://prnt.sc/1s7muex

    There does seem to be some kind of kyphosis that happens between T1 and T5 (screenshot: https://prnt.sc/1s7nbex) but it's kind of weird that when I'm lying down the kyphosis is at T1-T5 whereas standing it's from T5-T8, and in both cases it seems most of my back is not very kyphotic until it reaches that short kyphotic segment.

    Very last question is that on the MRI, it appears my cervicothoracic vertebrae (specifically T1-T3) are at least as much, if not more rotated than my thoracic vertebrae even though I have a thoracic major curve. But the picture is a little blurry because of breathing/movement for the cervical vertebrae, so I can't really tell if it's more rotated or not, what do you think:
    Screenshot: https://prnt.sc/1s7p1pz

    It should be noted that in my first x-ray at 12 years old, it seems like my cervicothoracic curve was actually bigger (EDIT: more like equal in size) than my thoracic curve but they diagnosed the thoracic one as the main one and didn't even give me a measurement for the cervicothoracic one: Screenshot: https://prnt.sc/1s7ogzm
    Although certainly now, my cervical curve looks to be the smaller one and seems compensatory because the top half of my neck is barely tilted at all whereas it used to be more curved when I was 12.

    I hope someone with more experience and knowledge than me can answer some of my questions, again sorry for the super long post and if I'm over scrutinizing my x-ray, just had a lot on my mind and trying to figure out what's unusual and what's not. Thank you so much if you read up to this point, I really appreciate it.
    Last edited by Spine_James; 09-14-2021 at 06:08 PM.

  2. #2
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    Quote Originally Posted by Spine_James View Post

    From the sagittal x-ray I just posted above, I thought my kyphosis looked a little weird because it wasn't a long/smooth curve like the other hyperkyphosis x-rays I looked at. I zoomed in a lot on the T5-T8 segment and I found a vertebrae that looked strange, it happens to be T7, the apical vertebrae of my scoliosis as well: T7_zoomin.jpg
    I see that....

    Who is your surgeon, and what did he say about this? Do you have any medical reports?

    It is possible to have single vertebrae with differing shapes....Short segment structural kyphotic deformity are called Gibbus deformity.

    You have some difficult if not impossible questions to answer here....

    How tall are you?

    Welcome to the forum

    Ed
    49 yr old male, now 62, the new 63...
    Pre surgery curves T70,L70
    ALIF/PSA 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
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    Quote Originally Posted by titaniumed View Post
    I see that....

    Who is your surgeon, and what did he say about this? Do you have any medical reports?

    It is possible to have single vertebrae with differing shapes....Short segment structural kyphotic deformity are called Gibbus deformity.

    You have some difficult if not impossible questions to answer here....

    How tall are you?

    Welcome to the forum

    Ed
    Thanks for reading. I did not know about Gibbus deformity, I just looked up pictures of it, it does seem like I have a version of that on my x-ray. I didn't know whether there was a name for that, so it's good to know now. Weird thing is I don't see that same shape on my MRI, not sure why. My surgeon is Dr. Samdani at Shriners, I haven't had a chance to talk with him about this yet because I just noticed these things over, I guess what must be over the last couple months, and I last met with him just before COVID started. The x-rays I have didn't come with a written report unfortunately. Up until now, I was under the impression that my MRI also did not have a written report with it, but I sent an email to find out, maybe there was a written report and I just don't have it on the CD they gave me. I'm 5'6.

  4. #4
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    James, Always get copies of your diagnostics burned to disc, and the radiologist reports. Sometimes, they don't like handing these out, but having these records in the future come in handy should you move or have a surgeon retire. I had that happen to me. Someday down the road "if" you need surgery, that new surgeon will want to see all your dated records...

    Radiologist's report everything they see and sometimes you will see things in reports that might seem alarming, which aren't....You can't panic over these things. You do need to discuss any questions with your doctor or surgeon. I don't know if you have a Gibbus, or Butterfly, as I am not an MD. I just read about these sorts of things as a lifetime scoliosis patient.

    At some point you will need to find another scoliosis surgeon....when is the question. You also have insurance logistics that need to be addressed as specialists are expensive. Very expensive. COVID is also something to be aware of as contracting viruses is not the greatest thing, it's not just the flu, and you can have lifelong problems from viruses....I had serious inner ear problems 30 years ago, (viral labyrinthitis) extreme vertigo, and have found studies recently linking this to COVID or being COVID induced. I look at my past, and look into scoliosis related subjects for posters here out of interest and support. If you are not vaccinated, do get your vaccinations.

    I suppose if you are interested in scoliosis and deformity, you could scour a few sites. It's good to know a few terms about spine when you go in and talk about things. The SRS site is a good site. It's good to go through the whole site. Education is important with scoliosis or any spine deformity. They have a surgeon locator, and you can ask them questions and have a scoliosis surgeon answer them.
    https://www.srs.org/

    You could check out King and Lenke classifications on curves....
    https://www.orthobullets.com/spine/2...ication-of-ais
    https://surgeryreference.aofoundatio...classification

    I can't answer your vertebral rotation/rib hump questions. It's seem's like its relative, but not always...my rotation was pretty extreme but my old rib hump I don't consider that bad. There are some really bad rib humps out there. I also had a large lumbar hump that comes with "S" curves, or both being structural. Your lumbar looks pretty good.

    You have upper thoracic issues that need monitoring and its not something I would ignore. I would ask Dr Sandami who you should proceed with. Having vertebral anomaly or malformations requires a good surgeon. Again, Shriners does what they do for free on kids so now that you are an adult, insurance and co-pays need to be addressed. Always address co-pays before doing anything or you could get stuck with a bill that will knock you socks off.
    https://en.wikipedia.org/wiki/Congen...tebral_anomaly

    I had inversion boots 40 years ago. Its been a long time.....I had them before the inversion tables came out. Your soft tissues counter when you invert and its debatable if it's worth it. I stopped using them around 1983. If you have wrist problems, you could simply hang your arm and wrist down and your doing the same thing....but does it help? It seems like it would make sense, but scoliosis is not gravity oriented. Traction is similar in that sometimes it can work, and sometimes it does not. I have had traction work, only to try it again on my neck with no positive results. Traction will not improve your curves. On kids with big curves, yes they will use halo traction before surgeries and get improvement, but they dont do this with adults. Growth stops and some of us get really stiff. Scoliosis curves also slow down and progression rates are slow. I progressed at .75 degrees per year up to my surgeries. From twin 50's at age 16, to twin 70's at age 49.

    When was your scoliosis discovered and how? School screen, or just regular doctor visit? Had Dr Samdani mentioned surgery to you? or your parents?

    Ed
    49 yr old male, now 62, the new 63...
    Pre surgery curves T70,L70
    ALIF/PSA 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

  5. #5
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    Quote Originally Posted by titaniumed View Post
    James, Always get copies of your diagnostics burned to disc, and the radiologist reports. Sometimes, they don't like handing these out, but having these records in the future come in handy should you move or have a surgeon retire. I had that happen to me. Someday down the road "if" you need surgery, that new surgeon will want to see all your dated records...

    Radiologist's report everything they see and sometimes you will see things in reports that might seem alarming, which aren't....You can't panic over these things. You do need to discuss any questions with your doctor or surgeon. I don't know if you have a Gibbus, or Butterfly, as I am not an MD. I just read about these sorts of things as a lifetime scoliosis patient.

    At some point you will need to find another scoliosis surgeon....when is the question. You also have insurance logistics that need to be addressed as specialists are expensive. Very expensive. COVID is also something to be aware of as contracting viruses is not the greatest thing, it's not just the flu, and you can have lifelong problems from viruses....I had serious inner ear problems 30 years ago, (viral labyrinthitis) extreme vertigo, and have found studies recently linking this to COVID or being COVID induced. I look at my past, and look into scoliosis related subjects for posters here out of interest and support. If you are not vaccinated, do get your vaccinations.

    I suppose if you are interested in scoliosis and deformity, you could scour a few sites. It's good to know a few terms about spine when you go in and talk about things. The SRS site is a good site. It's good to go through the whole site. Education is important with scoliosis or any spine deformity. They have a surgeon locator, and you can ask them questions and have a scoliosis surgeon answer them.
    https://www.srs.org/

    You could check out King and Lenke classifications on curves....
    https://www.orthobullets.com/spine/2...ication-of-ais
    https://surgeryreference.aofoundatio...classification

    I can't answer your vertebral rotation/rib hump questions. It's seem's like its relative, but not always...my rotation was pretty extreme but my old rib hump I don't consider that bad. There are some really bad rib humps out there. I also had a large lumbar hump that comes with "S" curves, or both being structural. Your lumbar looks pretty good.

    You have upper thoracic issues that need monitoring and its not something I would ignore. I would ask Dr Sandami who you should proceed with. Having vertebral anomaly or malformations requires a good surgeon. Again, Shriners does what they do for free on kids so now that you are an adult, insurance and co-pays need to be addressed. Always address co-pays before doing anything or you could get stuck with a bill that will knock you socks off.
    https://en.wikipedia.org/wiki/Congen...tebral_anomaly

    I had inversion boots 40 years ago. Its been a long time.....I had them before the inversion tables came out. Your soft tissues counter when you invert and its debatable if it's worth it. I stopped using them around 1983. If you have wrist problems, you could simply hang your arm and wrist down and your doing the same thing....but does it help? It seems like it would make sense, but scoliosis is not gravity oriented. Traction is similar in that sometimes it can work, and sometimes it does not. I have had traction work, only to try it again on my neck with no positive results. Traction will not improve your curves. On kids with big curves, yes they will use halo traction before surgeries and get improvement, but they dont do this with adults. Growth stops and some of us get really stiff. Scoliosis curves also slow down and progression rates are slow. I progressed at .75 degrees per year up to my surgeries. From twin 50's at age 16, to twin 70's at age 49.

    When was your scoliosis discovered and how? School screen, or just regular doctor visit? Had Dr Samdani mentioned surgery to you? or your parents?

    Ed
    Thank you for those links, I will read them to educate myself more. I'll try not to panic about anything I see until I talk to a surgeon or doctor again. I definitely want to ask them my questions when I get an appointment. I'm still under my parents' insurance, which I believe would cover surgery, so I'm debating whether I should get surgery now while that's the case, especially if I will have to get surgery at some point, which I'm not certain about either. I wasn't sure if Shriners would still take me at 19, if they only treat kids then I'll ask Dr. Samdani who he recommends I proceed with. I stopped doing inversion because when I came out of it I started getting a lot of pain in my left ribs. Although I still hang from a bar for traction without problems, but even hanging, if I have something near my feet that I can push against to get a stronger traction, I end up with the same left rib pain when I stand on my feet again.

    My scoliosis was first noticed at a regular doctor visit when I was 5, they measured a rib hump and recommended an x-ray. It didn't seem to get worse as I grew so we did not get the x-ray until I was 12, which showed a 20-degree thoracic scoliosis. Dr. Samdani did recommend surgery when I last saw him, and I was going to get surgery in 2020 but then the pandemic started, and I started school online last year too. I agree what's going on in my thoracic should be monitored. My parents and I heard about a new surgery they're doing on adults with a flexible cord, ASC, but I have doubts about whether it would work long-term or if my curve would qualify for that approach. I was going to reach out to one of the surgeons who do that procedure to see what they say. My doubt is, if scoliosis comes from wedged vertebrae, then if the cord breaks the curve would come back. I heard they change the shape of the disc in that surgery too, but if the disc is a soft tissue, I worry it wouldn't be able to resist the force of a wedge-shaped bone trying to drive the scoliosis back to where it was after the cord breaks.

  6. #6
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    Quote Originally Posted by Spine_James View Post
    I'm still under my parents' insurance, which I believe would cover surgery, so I'm debating whether I should get surgery now while that's the case, especially if I will have to get surgery at some point, which I'm not certain about either..
    Even though a lot of us have the clock running, having "elective" scoliosis surgery is not something you get done to get done as an adult. You don't run into it..... You have clarify what is happening with your upper thoracic first, that T7 level, and then see what the surgeons recommend. Since your surgeon has recommended surgery, chalk that off as being good news. If you have a situation where the surgeon says its highly technical, then seeing a 2nd opinion is a good idea. It's perfectly ok to want another specialist's opinion, your surgeon should understand. There is no rush, but do not ignore. I believe that your parents can have you on their insurance up to age 26, but don't quote me. Look into it.

    There is a video on ASC with Dr Antonacci on one of my threads. I believe they incise the disc and incise the anterior ligament, that's the difference between ASC and VBT. I don't think they can de-rotate doing this so if your rib hump is large, it might not be recommended.....I wouldn't be overly set on wanting tethering, leave all the technical decision making up to your surgeon. If you get fused from T1-T12, you would have all your lumbar levels intact and that is a good situation. Your mobility is going to be fine.....If you want me to find that video, ask and I will dig it up.

    When I say highly technical, I am talking about osteotomy. They have different types of osteotomy, this being a wedge cut to straighten up the spine. They cut a V shape into the back of the spine, then close the wedge and hold it with the rods. Osteotomy is used for kyphosis. It's also used for radical directional scoliosis correction, and improvements can be up to 30 degrees on a single level. Some of the osteotomies get technical because they operate around the spinal cord which is highly delicate. And your 19 with a lot of years left....Each procedure has a risk level. Your surgeon will weigh the risk and complications. Complications are things that can happen in scoliosis surgery and we all eventually get warned about these. They cannot explain all the complications that can happen as the list is pretty big....I was guaranteed 100% that something was going to go wrong. Complications can range from a band-aid falling off, to death.

    It was really smart of you to join this forum....years ago there was nothing. No support at all. I was a Luque wire candidate in 1975, but they didn't want to go there. A lot has changed since that time, technology has improved leaps and bounds in scoliosis surgery and of course across the whole medical gamut. It's important to be educated about scoliosis.

    Scoliosis surgery saved my life. I didn't have a choice. The pain of waiting for technology to improve all those years almost killed me but I made it.

    Keep posting and ask questions. If you want to talk, send me a PM and I will give you my phone number. I am currently retired so not too much going on these days.

    I grew up in Wayne, NJ. and moved out here for powder skiing in 1980. Here is a video after my surgeries in Jan 2011 at Donner Summit, Ca. I'm in the red jacket. I enjoy talking about skiing and scuba diving.
    https://www.youtube.com/watch?v=4tEy...annel=arvin332

    Ed
    49 yr old male, now 62, the new 63...
    Pre surgery curves T70,L70
    ALIF/PSA 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

  7. #7
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    Quote Originally Posted by titaniumed View Post
    Even though a lot of us have the clock running, having "elective" scoliosis surgery is not something you get done to get done as an adult. You don't run into it..... You have clarify what is happening with your upper thoracic first, that T7 level, and then see what the surgeons recommend. Since your surgeon has recommended surgery, chalk that off as being good news. If you have a situation where the surgeon says its highly technical, then seeing a 2nd opinion is a good idea. It's perfectly ok to want another specialist's opinion, your surgeon should understand. There is no rush, but do not ignore. I believe that your parents can have you on their insurance up to age 26, but don't quote me. Look into it.

    There is a video on ASC with Dr Antonacci on one of my threads. I believe they incise the disc and incise the anterior ligament, that's the difference between ASC and VBT. I don't think they can de-rotate doing this so if your rib hump is large, it might not be recommended.....I wouldn't be overly set on wanting tethering, leave all the technical decision making up to your surgeon. If you get fused from T1-T12, you would have all your lumbar levels intact and that is a good situation. Your mobility is going to be fine.....If you want me to find that video, ask and I will dig it up.

    When I say highly technical, I am talking about osteotomy. They have different types of osteotomy, this being a wedge cut to straighten up the spine. They cut a V shape into the back of the spine, then close the wedge and hold it with the rods. Osteotomy is used for kyphosis. It's also used for radical directional scoliosis correction, and improvements can be up to 30 degrees on a single level. Some of the osteotomies get technical because they operate around the spinal cord which is highly delicate. And your 19 with a lot of years left....Each procedure has a risk level. Your surgeon will weigh the risk and complications. Complications are things that can happen in scoliosis surgery and we all eventually get warned about these. They cannot explain all the complications that can happen as the list is pretty big....I was guaranteed 100% that something was going to go wrong. Complications can range from a band-aid falling off, to death.

    It was really smart of you to join this forum....years ago there was nothing. No support at all. I was a Luque wire candidate in 1975, but they didn't want to go there. A lot has changed since that time, technology has improved leaps and bounds in scoliosis surgery and of course across the whole medical gamut. It's important to be educated about scoliosis.

    Scoliosis surgery saved my life. I didn't have a choice. The pain of waiting for technology to improve all those years almost killed me but I made it.

    Keep posting and ask questions. If you want to talk, send me a PM and I will give you my phone number. I am currently retired so not too much going on these days.

    I grew up in Wayne, NJ. and moved out here for powder skiing in 1980. Here is a video after my surgeries in Jan 2011 at Donner Summit, Ca. I'm in the red jacket. I enjoy talking about skiing and scuba diving.
    https://www.youtube.com/watch?v=4tEy...annel=arvin332

    Ed
    I understand, I definitely want to clarify whatís happening at T7 first and see what is recommended from there, thank you for your advice. I researched the insurance and you are right, I can be under my parentsí insurance until Iím 26. I am glad I found this forum, our discussion has been valuable to me already. I'll stick around for sure and will ask if I have any new questions. Cool video, I love being out in a snowy forest like that, but I have not been skiing before, it seems like it would be fun.

  8. #8
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    You are so right about the help here. It is the best. We are here to answer questions from the patients that have gone through some amazing stuff.
    A question that I would ask your surgeon would be if fusion surgery is going to happen , would it be better while you are younger to help save the lumbar area.
    If anyone knows of help forum for shoulder surgery, can you let me know.
    T10-pelvis fusion 12/08
    C5,6,7 fusion 9/10
    T2--T10 fusion 2/11
    C 4-5 fusion 11/14
    Right scapulectomy 6/15
    Right pectoralis major muscle transfer to scapula
    To replace the action of Serratus Anterior muscle 3/16
    Broken neck 9/28/2018
    Emergency surgery posterior fusion C4- T3
    Repeated 11/2018 because rods pulled apart added T2 fusion
    Removal of partial right thoracic hardware 1/2020
    Removal and replacement of C4-T10 hardware with C7 and T 1
    Osteotomy

  9. #9
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    Quote Originally Posted by Spine_James View Post
    Hello! This is my first post here, please forgive the long post. It's been 2 years since I've seen my doctor, and I've been analyzing my x-rays these last few weeks and I noticed some things that I wasn't sure if they are unusual. For reference, I'm 19 years old, male, and have a 56-degree thoracic curve and 32-degree lumbar curve, and currently 23 degrees of rib hump/ATR.

    My first question:

    The coronal-plane outline of my ribcage seems to mildly follow the shape of my spinal curve on the concave side.
    coronal_xray.jpg

    I have seen other x-rays where the convex-side ribcage outline follows the shape of the spinal curve by bulging outwards in the middle, but I haven't seen any x-rays where the concave side ribcage outline dips in and out like mine does. (EDIT: My family and I believe this feature is an illusion from the rotation of my ribcage, but then why haven't I seen this more frequently in other x-rays, since all scoliosis has rotation?) I was hoping someone with more experience could clarify whether this is just some measurement artifact or just a postural thing? It happens to be a place where I feel pain (when I sneeze, go on an inversion table, or come up from bending over), so I'm not sure if that's connected, I've been told I'm not supposed to feel any pain from my scoliosis and I wasn't sure if maybe this is the reason for my pain.

    My 2nd question, relating to this x-ray and MRI: mri_vs_xray.jpg

    Is it unusual that the top half of my thoracic curve is significantly more curved than the bottom half of my thoracic curve?

    My 3rd question, also to the above picture: Is it weird that the curve size on my MRI seems similar or at least not much smaller than on my x-ray. I heard supine x-rays were supposed to be 60% of standing, but by eyeballing it and also measuring it using the built-in cobb angle tool, it really doesn't look more than a couple degrees smaller than standing if even that (although my lumbar curve does look much smaller, from what I could tell it corrects to around 2/3 of what it is on x-ray).

    My 4th question, is: I heard not having hypokyphosis is unusual with adolescent scoliosis, is this true? Because it seems like I do not have hypokyphosis, if anything I might have hyperkyphosis on my sagittal x-ray but I can't tell for sure, I outlined my vertebrae shapes in red in this x-ray so they are more visible: sagittal_xray.jpg


    Final Questions about sagittal alignment and cervicothoracic curvature:

    From the sagittal x-ray I just posted above, I thought my kyphosis looked a little weird because it wasn't a long/smooth curve like the other hyperkyphosis x-rays I looked at. I zoomed in a lot on the T5-T8 segment and I found a vertebrae that looked strange, it happens to be T7, the apical vertebrae of my scoliosis as well: T7_zoomin.jpg


    It seems to be longer in the back than in the front. I looked over my other vertebrae and it is the only one that has this shape in the sagittal x-ray. Is it unusual to have a single posteriorly wedged vertebrae? I looked back at my x-ray from when I was 12, and I could not find any posterior wedging of T7 on that x-ray, so it's not congenital.

    Further, is it even posteriorly wedged at all? Could it be some sort of error/illusion from my rotation? Yet thinking about it some more, doesn't all scoliosis have rotation, and if so, then wouldn't this posterior wedging be a common feature in every scoliosis x-ray?

    The reason I wonder whether it's an illusion is because, on my MRI, I zoomed in on the same T5-T8 segment and it seemed like my sagittal alignment was totally different!
    T5-T8 segment on MRI: t7s.jpg

    No posterior wedging when the MRI is centered on T7, and very little kyphosis too.

    Also, the sagittal ribcage outline of my MRI is pretty straight, doesn't seem to be kyphotic, here's a screenshot to show you what I mean: https://prnt.sc/1s7muex

    There does seem to be some kind of kyphosis that happens between T1 and T5 (screenshot: https://prnt.sc/1s7nbex) but it's kind of weird that when I'm lying down the kyphosis is at T1-T5 whereas standing it's from T5-T8, and in both cases it seems most of my back is not very kyphotic until it reaches that short kyphotic segment.

    Very last question is that on the MRI, it appears my cervicothoracic vertebrae (specifically T1-T3) are at least as much, if not more rotated than my thoracic vertebrae even though I have a thoracic major curve. But the picture is a little blurry because of breathing/movement for the cervical vertebrae, so I can't really tell if it's more rotated or not, what do you think:
    Screenshot: https://prnt.sc/1s7p1pz

    It should be noted that in my first x-ray at 12 years old, it seems like my cervicothoracic curve was actually bigger (EDIT: more like equal in size) than my thoracic curve but they diagnosed the thoracic one as the main one and didn't even give me a measurement for the cervicothoracic one: Screenshot: https://prnt.sc/1s7ogzm
    Although certainly now, my cervical curve looks to be the smaller one and seems compensatory because the top half of my neck is barely tilted at all whereas it used to be more curved when I was 12.

    I hope someone with more experience and knowledge than me can answer some of my questions, again sorry for the super long post and if I'm over scrutinizing my x-ray, just had a lot on my mind and trying to figure out what's unusual and what's not. Thank you so much if you read up to this point, I really appreciate it.
    While I'm not a medical professional, I don't see anything unusual here. If you want to know if there is a problem, look at the radiologist's report, or talk to your spine specialist.
    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

  10. #10
    Join Date
    Jan 2008
    Location
    NC
    Posts
    9,317
    I second Ed's and Linda's suggestion that you obtain all the radiologist's reports. They are the only people who can competently review your images. If they don't remark about something then it is not concerning or unusual.
    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."

  11. #11
    Join Date
    May 2008
    Location
    reno,nevada
    Posts
    4,445
    It's not an easy thing talking to doctors and surgeons about our scoliosis....It's very personal and emotional discussing our situations and our outcomes. It's hard on both ends, for doctor and patients discussing material that we are not educated about. As patients, we are completely reliant on their expertise, for doctors it's extremely difficult to explain things proven or not, going on past history, outcome stats, new science, techniques, and products.

    For adolescents, it's all completely unknown extremely complex material...this new subject matter that requires a long and tough learning curve.....What is this? Its Biology 101, the hard way. Forced science class...and for those that are not into science subjects, can be difficult.

    My goddaughter became an emergency PED doctor and surgeon at St Louis Childrens...Over the years I saw her change, the 18 hour per day study time for just under 2 decades changed her dramatically. When I ask her questions, she goes into overload and strains trying to explain how things work on a lay level.... It's almost like I force her to speak in a different language. She also has a job where she doesn't talk to too many parents as she hangs out behind the scenes when they roll in. Decisions have to happen extremely quickly to save lives. In the medical field, it's as intense as it gets. I guess Psychiatry would be the exact opposite when it comes to communication as a medical doctor. Some doctors communicate and some do not, or do it well.

    If we only knew all the material we would have a complete understanding of what happens and what can happen to us.

    I must say that James 1st post was excellent....some really good observations, and great questions.

    I had a hunch James was a congenital or early onset case.....I don't know if James shot any CT scans or if his surgeon was ready to do that next....This COVID thing has really been a pain for those like James and Jackie and others that are close to surgery. There could be a chance that Shriners would do the procedure under the circumstances. The only way to know is to ask.

    When I went to Colombia in 2013, Linda Ronstadt reported that she had Parkinsons and cannot sing anymore....In 2019, she reported that she has (PSP) Progressive supranuclear palsy. The same disease that Dudley Moore had and everyone thought he had an alcohol problem....Remember?
    https://en.wikipedia.org/wiki/Progre...anuclear_palsy

    I know this is neuro, BUT can't help but wonder why some of these decisions take so long. 6 years.....I guess this proves that there are no simple answers, and some disorders progress slowly. Her new diagnosis was probably discovered by new diagnostics, new MRI technology, and probably other specialists....

    Ed
    49 yr old male, now 62, the new 63...
    Pre surgery curves T70,L70
    ALIF/PSA 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

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