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

[Maria]

Judy,
the foot surgeon I want to use is someone I worked with when I was an NP at Pacific hosp. in LB. Actually she was in her residency back then. I really like and trust her so I want to have the surgery done at LB Memorial and before I have this done I have to have pre op visit w/my PCP, a chest xray and EKG and labs and then see this Podiatrist too the week before surgery so imay as well be in LB to have all this done with surgery included.

Here I have some friends that can help me out whereas when I move I will have so much to do and boxes to unpack and so much to do.

My closing date was supposed to be 4/19/2011 tho I'm waiting on the rest of the trustees to sign the contract before I sign it and everything is a go. For now it's "pending"~ I can't wait to get this done!!!!

Oh BTW I wanted to get most if not all the packing out of the way before I get myself in a position that I can't do anything but rest!

Hope you're recovering well and that's the other thing ... I know my back will be torqued from gimping about when I have surgery so want to get everything out of the way if possible before I can't do hardly anything and my back is going to be a big mess from "gimping" while on crutches and such!

[jsewell]

Maria do you mean you want to have the surgery before April 19th? THat is soon to be trying to accomplish all of that. That is cool that you worked with this doctor.
I did all the pre op stuff at my primary docs office a week before. I didn't have to do the chest x-ray , but usually so before surgery. Seeing i go to my pulmonologist every few months i usually can use one of those for my surgeons. I skipped the pre op with my surgeon because i had just seen him and discussed the surgery the week before. He had noted what he would do in my chart . It did all happen very quickly though.

My back can not handle the lopsidedness at all. It also cannot handle sitting in bed all day for days on end. But overall it is not doing so bad. The injections did a lot of good . It took away all of my butt pain on both sides.
Yes, i would definitely pack before the foot gets done!!
judy

[Maria]

Judy,
I'm not sure exactly when I want to do it.. just want to close on the co op first I think. I don't like the idea of being "down" for 2 weeks as sitting and laying down bothers my back whereas walking is what always makes me feel better!

also limping and using crutches bothers me a lot tho I hope I only go thru a month of being a bit messed up gait wise and my back will straighten out easily.

Currently I did something to my neck yesterday. It's not bothered me for a while so I hope I get over this pretty quickly.

Hope you're healing well and will soon be walking Ok so that your back won't bother you much longer. I think I recall w/i 2 weeks post the hammertoe surgery I was doing pretty good. Maybe 3...

[jsewell]

Hi Maria,
Seems like i will be doing OK by the time you decide to bite the bullet so don't forget me as someone that can help a few times.
I know i sure don't feel like going to the grocery store at all. But if it was just me i could stock up with most stuff and be Ok for a few weeks anyway,. but there is the taking out of your puppy too. I wish i was closer.
Today i was cleaning the kids bathroom (it was disgusting), I gave them the job about 10 days ago and they did nothing. Anyway i bumped my good baby toe on the door as a towel on the floor was stuck. think i broke it, it has been hurting more than my operated on foot. Just my luck.
I am still only walking rarely and only on my heel. Yesterday was when the boredom hit. Not yet today!!
Seeing i am flying Tuesday, not sure if i will take a crutch or my cane. Guess i will try them both out in the house or driveway tomorrow.
How is the packing coming along?
judy

[Maria]

Hey Judy,
I'm doing pretty good w/packing and my hub took Lola so I have alot more time to concentrate on packing w/o having to go out 4 time/day to walk the dog plus when I have surgery I will not have to walk her. I will have to take care of the cats re litter and feedings and also find someone to give Winston fluids sub q if I can't do it which I doubt the first week I may feel like doing. Actually so far I've not been able to convince Winston I can do it so have had to take him to the Vet for this.

I think I probably won't move till at least the end of May. That way I can get the surgery over with and be where people can help me out and then recover enough for the move and be able to do stuff when I get in my new place~ like end of May beginning of June.

At least this is what I'm thinking today!!! It'll be weird to be hanging out around a bunch of packed boxes and really boring tho hopefully the first week I'll be in too much pain to care and the 2nd week I'll be getting better and by the 3rd and 4th week I hope I'll be making serious progress. I'm a bit worried with the lymphedema in that extremity (right leg) and hope it doesn't blow up beacause of the surgery. I thnk tho if I keep my foot and leg evevated most of the first week after surgery I should do pretty good.

I'll have a hard time trying to bathe/shower in my current apt. with the surgery tho I hope that too will be OK. I definately keep you in mind for help tho hopefully I'll do Ok with the people around here that can help me.

Too bad you had to clean the bathroom as that's something I worry about having to do but with regard to cleaning up after the cats in the bathroom vs. kids! I hope your toe that you think broke is OK and hope you heal really quickly~ I think the swelling with the hammertoe surgery is the biggest thing once the first week or two passes then you just have to have shoes that adapt basically..if my memory serves me correctly!

Hope you'll do Ok in the airport next week! take it easy and just try to heal before you have to travel! Maria

[jsewell]

Maria, I don't think i will have time to heal before i travel!!! I'm leaving Tuesday mid day. So less than 48 hours. I just hope now that my baby toe is not hurting by then!!
Good idea to move in May and get everything done now. I think after my never block wore off i had some significant pain , worse the first and second nights, then hardly noticeable at all. I didn't need to take anything for it or my back. I did take one dose every 24 hours so i didn't have withdrawal symptoms. I've been taking my 20mg doses of percocet for 4 years now. Several times a day. WEll about 3.

I stopped cleaning after the toe incident today. Now i am a little antsy!!
judy

[Maria]

Judy,
I think I've broken one of mine several times or at least felt like it. I think that pain/swelling goes down pretty quickly tho so you should be Ok re that toe soon.. at least if memory serves me correctly as there is nothing that's done re broken toe.


The healing of the hammertoe surgery seems to go pretty quickly as I recall tho I remember the more time I spent on my feet the more the toes would swell tho I guess when having 4 done it just seemed like they were swollen most of the time!

Hope your trip goes Ok tomorrow. This is for your Dad's burial correct? Continued condolences sent and hope your Mom is doing OK by herself.

take care Judy and I won't say don't overdo tho hope you don't hurt yourself doing anything and the toesies heal OK with your schedule~ (and everything else will be OK/head/neck/etc).

[jsewell]

Maria,
Thanks for your well wishes. I didn't even look until this morning for swelling on my good foot. Yep, i should have iced it yesterday. There is also something inside it (bone) that moves . It is still painful. I am such a clutz. I probably did this at least 2 times in the past, but i don't remember it hurting this much. Lucky me. i guess i really do need the wheelchair i ordered for the airlines!!

Can your hubby take Lola when you have your surgery? That would be perfect. you may have already said that. Bad memory here.

I am so tired today. I couldn't fall asleep before 1:30 and i was up by 3:30 tossing and turning. The night before i got a decent nights sleep and what a difference it makes.
i see you were up early too.
I can't wait to see the unbandaging of my foot tomorrow. as there is a deep bruising on the outskirts of the bandaging, my daughter wants me to take a picture of it when it is uncovered briefly!!
take care,
TAke it easy packing, although now you do have time.
judy

[Maria]

duhh.. don't even remember that much bruising but I'm sure I had it too! I think if you hit your little toe that might have impacted your overall foot and caused even more bruising. Maybe I'm wrong. When I thought I have broken my little toe I taped it to the next toe tho when you've recently had surgery on the toe next to that and others that might not be the best idea.

I do hope that your progress will just keep going along and you wont' be feeling more pain after awhile when you've given it just a bit more time.. You'll see things will get better!!! take it easy whenever you can Judy.. it's being inpatient that often gets us into trouble (believe me I know only way too well)! I have to constantly remind myself to not get into things all the time!!!! take care! Maria

[jsewell]

Maria it is my non operated foot that i banged. Just my little pinky toe.
My spine surgeon gave me the OK to start physical therapy on my back. It is going to be targeted on my pain when i try to stand up straight. As all other back pain is gone.
About the spot on my neck that hurts. He thinks it is a knot of muscle . He said in 3 or 4 weeks if it is still bothering me he can give me a shot in the neck. So we will see. I'm not convinced it is not the loose screws. But the knot did change its position a little this past week. So maybe he is correct. It also seems a bit smaller.
He said i should be healed now from the surgery last August. So next time we will take the x-rays to see about my alignment.
Speaking of packing, time i got started!!
judy

[Maria]

Judy,
both feet ailing huh?? hope they're both OK today for travel! Re the neck knot it does sound like maybe a muscular thing just maybe from so much work to compensate.. hope it keeps going down!

Hope all goes well w/PT when you get started. I have a good friend getting a one or two level fusion this a.m. and she is 71. She should just be going into the OR now. I hope she'll do well w/no complications. She has been in a world of hurt for so long now..

thankfully whatever I did to my neck is better!! Yippeee! I got a bike yesterday so my back is hurting a bit from riding it tho I'm going to keep trying! Hope I can manage at least a few short rides/week. I think the impact right up my tailbone to affected disc(s) is bit much for me tho I'm willing to give it a bit of a go and see.

now stay out of trouble Judy!! take care!

[mmglobal]

get a high quality springy seat!

[Maria]

bike riding going well w/no back or other pain! I'm riding a Giant 21 speed city bike (hybrid). The seat is very comfortable (this is a guy's bike) and has that "springy thing" (can't remember what it's called at the moment). I rode my friend's Townie today w/special seat and that bike is really nice tho I like the stearing on my bike better. His Townie is so lightweight feeling and can't feel bumps in road at all! Amazing!

[jsewell]

I have been afraid to try bike riding . I have a bike, kind of a hybrid mountain bike. I will not be taking it to the mountains , the bumps would probably kill me. Glad you are having success with bike riding Maria. Certainly easier on the feet.
judy

[Maria]

Judy,
I've been wearing sandels half the day and also biking instead of walking plus my dh has Lola for now while I pack so my toe hasn't been driving me nutz at all. Thankfully as I wanted to chop it off!!!! Biking here is pretty easy re flat terrain tho I don't like all the traffic. Where dh lives there are some great trails for biking tho I don't know if I could actually get up and down the inclines even with the 21 speeds. I mean my back is OK with flat terrain and such tho not sure about steeper terrain. Still it is so nice to ride~ using a good helmet which is something I never used to do re bike riding. Flat hair..ugh! (better than alternative re flattened head).

[jsewell]

Yes flat hair is much better than a flat head!!!!!
Glad you are enjoying biking and getting a break from your foot pain. Still my little broken toe hurts the most. Well just as long as i don't try to bend any of my operated on toes. I wore sandals (flip flop ) last night at DrFriedman's clinic. Did ok. I did sit as much as i could, but still have to walk to another suite to make copies.
I see the doc next Tuesday for my foot and see what i get to do next!
Do you know how long those steri strips are supposed to stay on . He put them on over the place where the stitches were and it has been over a week. I can't remember how long they said to keep them on. I guess i will call today.
judy

[Maria]

They usually come off on their own, esp. if showering and getting the foot wet. I'm so glad this time I only have the one toe plus the bunion to do tho I do worry about the bunion part since that's no driving for a month.

I'm packing and only have my futon sofa to sleep on in the living room and bedroom looks like

I think I should have done the surgery first and worked on buying something/moving later~ got worried that I'd have no energy to pack in the heat tho as I get so lethargic when it's hot in the stuffy apt. even tho I have a window a/c in it still feels like swampland when it gets hot here.

I can't believe you voluteered the other night! you're amazing!!!!!

[jsewell]

Hi Maria,
The no driving thing is going to bother me when i finally have the right foot done. I need all 4 toes done for sure, this foot looks worse than the left one did. I am at about 2 and 1/2 weeks with the left and no way could i drive on it yet if it were the right foot.
I was up and out pretty much all day yesterday. I am still using the ace bandage to keep swelling in the foot down. It works and provides a padding on the ball of my foot which helps. If i touch the toes on the bottom of my foot they really hurt still.
I was out and about with my son all day yesterday or cleaning this disaster of a house when we were in between things. I really need to get some food in this house today so will be out again.

Yesterday my back was bothering me , I really felt like i was leaning forward and could not stop and right myself. I am really worried that physical therapy will not help with the alignment problem . I hate to even think about the other options. One being to remove the hardwear. The other more drastic. Although removing the hardwear would mean opening up my muscles yet one more time.
I don't start physical therapy until the 26th as my therapist is so booked .
judy

[jsewell]

Not sure about the alignment problem , I went to see my spine surgeon and he discovered a fracture in L-4. He is sending me for a complete bone scan before surgery to help it. He will probably take the screws out and put some cement in. I can't believe this is happening now. I may never get healed enough to go to work.
judy

[Maria]

A fracture at L4? Like a stress fracture? So is that vertebroplasty they'll do there? I've heard taking out the hardware isn't nearly as big as putting it in tho it seems like you had some levels done or reinforced not too long ago? I start to get things all mixed up.. sorry!

I'm still working on getting my closing date and haven't made my surgical date yet. I even forgot to write down my preop date... sheesh! I really can't keep stuff straight hardly!

Well hopefully I'll hear about my closing date ASAP so I can plan for things and do my surgery. My back was driving me nutz not too long ago so didn't even get to pack anymore plus I'm just plain ol' sidetracked w/good beach weather. Not that I like to go to the beach and sun anymore just like to walk it and see it. I'll miss being as close as I am to it even tho won't be far from it tho Laguna seems a bit more "busy" than Long Beach and Bolsa Chica, Huntington and some others at least what I saw of it on Easter weekend.

take care Judy and keep me/us posted on what's happening next w/your back.

[jsewell]

Hi Maria
You have a pre op date before your surgery date is set? Mine always have to be within 2 weeks of the surgery date.
No it is not a stress fracture as far as I know. He just said it is fractured. I had this level done for the first time last August. At that time he redid some that were not fused yet and took out a few screws here and there(I think) Also did one diskectomy. I'm almost loosing count myself.
If nothing is going to be down about my alignment at that time he will do kyphoplasty. that is what he has done in the past.
judy