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

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    May 2021
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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.

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