Corrections

Scoliosis or Shift?

Contrary to widespread belief, not all shifting on a front view x-ray qualifies as a scoliosis. While there are a few different types of scoliosis curves, a scoliosis is by definition a skeletal deformity. In a nutshell this means that the shape of the spinal bones (vertebrae) develop in an abnormal shape. Our office often sees patients that have frontal x-ray shifting with no quantifiable bone architecture changes that have been previously misdiagnosed as a scoliosis. While a scoliosis diagnosis means that a patient’s spine will never be in an “ideal” range, it is incredibly valuable to reduce shifting associated with a scoliosis curve. A simple way to summarize is that all scoliosis curves have shifting, but not all shifts are scoliosis curves. While the alternative is a “wait and see” approach or strengthening a crooked spinal structural, our office customizes a process to reduce the shifting of the scoliosis, stabilize it in that position, and teach strategies that last a lifetime all without the use of surgeries, drugs, or bracing.

Degenerative Spondylolisthesis aka Spondy

Spondylolisthesis when broken down means spinal (spondy-) slippage (listhesis). While there are different types of spinal slippages, the most common type originates from disc degeneration causing a bone to start to slip forward (antero-), backward (retro-), or even sideways (latero-). Traditionally this type of condition is also put into the category of “wait and see”, running the risk of further wear down, further slipping, and secondary problems arising from the slippage. Secondary problems from a spondylolisthesis consist of canal stenosis, nerve root obstruction, and further disc deterioration just to name a few. While this condition was previously thought to be uncorrectable without the use of surgical intervention, our office is one of four facilities in all medical peer reviewed literature that have proven corrections of this condition non-surgically. Apex is continuing its pursuit of further research regarding this subject.

Anterior Pelvic Tilt (APT) With Resulting Excessive Lordosis aka Swayback

Anterior, or more commonly known as forward pelvic tilt is a common problem seen in our practice because of its inevitable compensation of the rest of the spine. With the pelvis and sacrum acting as physical foundation that the spine directly attaches to, problems with the foundation causes widespread secondary problems very similarly if a house has a cracked or titled foundation. This foundation shift causes a very noticeable indentation in the lower back, what many people commonly refer to as a “sway back”. It is not uncommon for some to develop this type of foundational skew post-partum. While some spines “bounce back” after pregnancy, some remain in a shifted position and settle there. Patients with this type of foundational skew can experience a wide array of problems such as disc degeneration, nerve root obstruction, facet syndrome, and more.

Anatomical Leg Length Inequality (ALLI) aka Short Leg

In reality most people have some discrepancy in leg length, a common notion misconstrued by many in physical medicine. The nuance when diagnosing a leg length inequality is size. When leg length measurements reach a certain threshold, there must be a difference in bony architecture of the lower extremity (ankle, foot, tibia, or femur) that causes the problem. When this threshold is exceeded, it is not feasible for this type of problem to be originated from a muscular imbalance. Unfortunately, these types of problems are commonly looked over and/ or the unrealistic notion is presented that a short leg can just be “popped” or manipulated back into place. When analyzed properly, a customized plan of action for a patient with a short leg focuses not only on the foundational deviation but supports it and addresses any inevitable compensatory shifting above it.

Excessive Kyphosis (Hyperkyphosis) aka Hunchback

This type of structural deviation is one of the fastest growing spinal problems in modern society. A thoracic hyperkyphosis, known as a kyphosis by many, is an excessively rounded middle back curvature when viewed from the side. While the thoracic spine (middle back) is supposed to have a kyphosis, when it excessively rounds it creates a laundry list of problems. Many associate this type of spinal problem with visible lazy “posture”, but those with a true hyperkyphosis cannot just simply pull their shoulders back and expect their kyphosis to unbend. This would be akin to pulling on your drywall and expecting the foundation of your house to level. While there have been many devices developed to try and roll out the restrictions of an excessive kyphosis to hear some audible pops, correcting this underlying shift is much more complex. Like our scoliosis topic, in adolescence an excessive kyphosis can be because of an underlying deformity known as a Scheuermann’s Kyphosis, where the front of the vertebral segments develops in a wedge shape. The younger this shift manifests, the more likely that it is a result of this condition. Whether an acquired shift or not, these types of shifts are better reduced at a younger age bracket as they tend to continue to progress as a person ages.

Anterior Head Syndrome (AHS)

Anterior Head Syndrome (AHS) is a condition that virtually everyone has seen in their day-to-day life. When the head shifts because of lifestyle factors, whiplash trauma, etc, it can create a noticeable bump at the back of the neck. This bump presents when the bony structures at the back of the spinal bones, the spinous processes, approximate and rub against the surface of the skin and soft tissue, creating an inflamed response. Many see this bump as a bit of a mystery in origin when it is commonly resultant of this type of deviation. While this is only one secondary condition that AHS can cause, it is the most noticeable to the public.

Loss of Cervcial Lordosis aka Military Or “Text Neck”

Analogous to the rise of the excessive kyphosis in the public, loss of cervical lordosis (neck curve) has become much more commonplace. With many more people working from home, kids using technology for school, and cell phones being an absolute essential, it’s not much of a secret as to where many neck problems are originating. When the neck curve is lost, it is similar to having a car with an improperly aligned suspension. The longer the suspension problem stays unchecked, the more damage to the tires, brake pads, and other mechanical components. A similar process occurs to the bones, discs, and soft tissues of the neck when there is a lacking suspension platform for the average human skull, weighing in at approximately 11 pounds. Imagine carrying a bowling ball all day long and you’ll get the gist. While we don’t expect any patient to have a 42-degree picture perfect neck lordosis, just like we don’t expect a perfect 120/80 blood pressure or 98.6 degree temperature, the more off range a neck curve becomes, the more damage it can create over time.