Alignment Problems Anyone?

[jsewell]

I have had many extensive back surgeries. The last of which was in August of 2011. At this time , my fusion level was brought down to L-4. At this point i am fused or fusing from C4 thru L4.
I now have a difficult time standing straight up. when i stand i always have my knees bent. I read about flat back syndrome and although i am not totally flat (my lumbar lordosis is too low and possibly at a minimum) my symptoms are described by that syndrome. Back pain, and the sensation of falling forward. Since this has been going on my gait is different and i have developed hammertoes!! Not sure if that is related. I am having correction in one foot tomorrow.
Just wondering if anyone has experienced anything like this or other problems with alignment.
judy

[mmglobal]

This is me thinking out loud. I can be completely wrong about this. I'm not a doctor... yada, yada, yada. I found Judy's question interesting. Here is what comes to mind.

In other contexts you've seen me write about sagittal balance and compensatory curves. Like with the deformation of a lumbar vertebra that starts your spine off at an angle that is far from perpendicular (to the ground), there must be a compensatory curve or your head would not be over your body!

With certain types of fusions, the structure and angles of the fused configruration can be critical. For those with such severe cervical problems that they must be fused from C0 all the way to the thoracic spine, they lose all motion of their heads relative to their bodies. If the angle is too far forward they cannot look up or level without leaning back. The converse would also be true.

You can picture that if you have something that is off by 5 degrees in your cervical spine, it would not be noticed in your posture. If you have something in your lumbar spine that is off by 5 degrees, there will be a compensatory curve that will be relatively small and your posture would not be unusual.

All this brings me to.... if you fuse the entire spine so it is like a straight rod... then a vertebra off by 5 degrees in your c-spine will be no big deal. Tilt one 5 degrees in your lumbar spine, then because of the long fusion, your head will be outside of where your shoulders should be. The longer the distance between your head and your off-kilter vertebra, the larger the offset would be.

I don't know it this is related to your case or not. But, if you had a bunch of short fusions that had normal segments between them, that allows for the needed compensatory curves that will compensate for the structural off-kilteredness. (did I just make up a word?) If you then fuse all the short fused segments into one large fusion, then there is no ability for your spine to compensate for the bad angles below. Is it possible that a part (or parts) of your fusions are out of whack and there was no problem until you could no longer compensate for it?

If you felt like you were falling forward immediately after the last fusion, then my theory would hold water. However, if this feeling is new, I woud be very concerned that something is changing. I don't remember you describing that sensation when we've met. Have you discussed this with your spine surgeon or PM?

Do you have recent A/P and lateral views of your entire spine? (or saggital and coronal MRI or CT?) It would be interesting to discuss them.

All the best,

Mark

[Maria]

I remember Judy mentioning this after her last spine surgery I believe which is at least several months ago. I'm surprised however that the hammertoes just occured tho I can imagine that maybe when you're walking Judy and leaning forward that your toes (like mine) are grasping (like claws almost) at the surface of the shoe and hence the hammertoes.

When I"m wearing sandels that are open toe and not walking fast (as in power walking) just hanging around all day the foot that bothers me (re toes) is OK.

Problem is my right ankle isn't OK as I need to use an orthotic or insert in tennis shoes for my flat feet so can't walk around all day in sandels.

Anyway.. this is about you~ sounds like what Mark is saying makes sense re fusing of practically your whole spine and the natural ability for the spine to compensate being reduced or even gone mostly.

You see it in older people whose spines who have lost their natural curvatures of their spines...the bent knee sort of pitched forward stance only usually with head looking down... often seen w/cane for support.

[jsewell]

Maria is right Mark, this has been a problem from Augusts surgery. I have discussed it with my spine surgeon who showed me that i do not have a flat back. My lumbar lordosis is lower than normal . My head is already in a forward position also.
My doc said that when and only when everything is healed from the surgery last August he will take a standing x-ray and check out my alignment. It does tire out my upper back when walking as well.
Thanks for thinking out loud and I think you surely did make up a new word.

Well one foot is corrected. I have not read anything about flat back effecting toes, but it does affect knees and hips , oh joy!!

judy

[Maria]

Judy,
I actually did read something about spontaneous hammertoes being caused by the toes acting like claws because of persons walking a certain way lifting off more on their toes than their heel so I think your overall gait during hiking could be what created the hammertoes.

With me I've had them forever and the one toe just got worse. Probably also speeded along by my agressive long distance walking where I would force my toes to a certain position w/my gait.

I've not scheduled surgery yet as I'm buying a co op in Laguna Woods Village so now I have to pack yet I want to get that surgery done here w/my podiatrist so don't know how I'll work all this out~ it's good you got it over with. How're you doing??

[jsewell]

Hi Maria,
My pm doc also says i have a neurological problem where i do not sense the ground . I notice when i am walking just barefoot how the toes turn into claws. Now they are permanently in that position. Once the nerve block wore off on Monday night it did hurt enough to take pain meds. Also on tuesday , but after that it only hurts when i try to walk!!! I am trying to use only my heel and i only went downstairs once yesterday to make coffee. Other than that ,it does not hurt at all just sitting here or laying here. I know i am allowed to walk around the house now, but can't really do anything so why bother. Standing today making breakfast my left side of my back started hurting with my lopsidedness. So i won't be doing too much of that!!

I'm glad you found a place to purchase. Do you have a moving date or closing date? That is very exciting. Hope you can get your feet straightened out too. (no pun intended)
judy