How to read your X-ray
X-rays can be daunting to read, even to the trained eye. X-rays in patients with a scoliosis diagnosis are tricky in that there is a spinal shift and a spinal rotation. Charlie Johnson, a Certified Orthopedic Specialist, does a great job in explaining how to read an X-ray. Look him up on Youtube.com
What you are currently looking at below is my personal X-ray, taken in 2017. At the time, my curves were just below Moderate in severity. So, in looking at an X-ray, draw a vertical line down the center. See how much spine is to the right and left of the line. In the X-ray below, you are looking at the person, me, from the front. Here’s a couple of interesting points. In 2017, my thoracic spine showed a curve of 21 degrees to the right. My lumbar spine showed a curve of 23 degrees to the left. There is also some retrolisthesis (a side shift) at L4-5. My right hip is slightly higher than my left.
Visualize the spine like Ranch Road 620 in Lakeway
So, I am switching gears for a minute to help you understand better how these curves might affect a person. Imagine you’re driving your car. Let’s suppose you’re on Lakeway Blvd and you are turning left at the light onto RR 620. You might prefer the inside turning lane because the outside lane requires you drive further out before turning in. Now, using this image, imagine looking at an x-ray where the spine seems to curve right and then left. When it curves to the right in the thoracic cavity, it causes the ribs to protrude to the right.
Sometimes, it can even rub raw that part of your ribs against your bra or bathing suit top. Going lower, the spine straightens out but then veers to the left.
That left side is “the outside lane” and has more space in the spine. The right side is “the inside lane” and has a shorter distance. It brings the hip closer to the ribs.
If these curves were more like 30-40 percent, it could prevent the person from breathing properly because the lungs are getting compressed. When the spine starts to veer right, we call this a Dextrothoracic curve. When it goes back to the left, it is called a Levoscoliosis curve. The most common type of scoliosis curve is called a Reverse S-curve, which is exactly what I have. How lucky am I! Now, because my right hip is 2.86 mm higher, it makes my right leg appear shorter. In order for my right leg to be completely straight, I have to bend my left knee a little bit.
Are there other curve patterns?
There are basically 4 different curve patterns. Mine as discussed follows b. Reverse S-shaped Scoliosis.
Single curve, Thoracic DextroScoliosis. It is a right C-curve. Imagine a straight line with a hump on the upper back at the shoulder.
Reverse S-shaped Scoliosis. This is when the lumbar curve goes left and the thoracic curve goes to the right. This is the most common type of curve.
C-shaped Scoliosis. Imagine the letter C. The rib hump goes to the left. The spine spells out the letter C.
S-shaped scoliosis. This is a left thoracic curve and a right lumbar curve. THis is not very common and often is a sign of an underlying syndrome.
How do we know if our curve is mild, moderate, or severe?
There is a handy tool called a Scoliometer. It looks like a level. You stand behind the patient with your eyes at the same level as their back.. You ask the patient to slowly go into a forward fold. The client looks at their shins. Find the folding position where the curve is the most extreme. Lay the scoliometer on the back and read it somewhat like you read a level when hanging up a picture. You can even download a scoliometer app on your phone!
Here is an example of the practitioner using a scoliometer on a patient, in a test called the Adam’s Test.
The client is asked to slowly fold forward. In this case, the client has a rib hump on her left
thorax. The scoliometer will tell you the degree of the curve. It is often used with the Cobb-angle measurement. The patient in the Adam’s test picture has a C-shaped curve.
The Cobb angle measurement process was developed in 1948 by Dr. John Robert Cobb. A curve of at least 25 degrees is typically considered moderate scoliosis. The measurement includes the following steps.
The patient stands while a front view x-ray of the spine is taken.
The doctor uses the x-ray to locate the apex vertebra, which is at the deepest part of the scoliosis curve, as well as the most-tilted vertebra above the apex and most-tilted vertebrae below the apex.
A perpendicular line extending from the most-tilted vertebra above the apex is drawn. The same is then done for the most-tilted vertebrae below the apex.
Where the two lines extending from the most-tilted vertebra above the apex and most-tilted vertebrae below the apex join together gives the Cobb angle.
What can be done about scoliosis?
I’ll start off by sharing that my lumbar curve was a 26 degree curve in 2009. It continues to improve. My thoracic curve is down to 19 degrees. The key question to ask yourself is this: Are you most concerned with the physical look of the curves or are you most concerned with pain? To me, the answer is both! Learning all you can about your curves and how they might affect your hip height, your shoulder rotation, your rib and/or lumbar rotation is a lifelong process. Every single person with scoliosis has a unique case.
Here is the best way I know how to simplify the healing process.
Where is the “inside lane” of your curves? These curves need to be elongated. Stretching these muscle fibers can be very helpful. Where is the “outside lane” of your curves? These muscle fibers are weak and often over stretched. They need to be strengthened. This is why I insist on looking at your X-rays and X-ray reports. I do not diagnose but I can help you develop a specific daily routine to manage your curves and ameliorate your pain. We also must look at your posture, head to toe, to see how your body might be overcompensating for the curves. This is fun detective work.
I didn’t even explore the rotation component and scoliosis in the neck, although I do have both. This may be saved for a future article. Please never settle for surgery until you know everything there is to know about your particular case. Let me know if you found my article helpful and please share it with someone who is battling the scoliosis diagnosis. Let’s get to work!
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