Recent E-Mails

On Non-Patho and Patho Compensatory Curvature of the Thoracic Spine…

We are reviewing an article on spinal rotation that is really good.  It establishes some definitive information on the fact that nobody is symmetrical and that everyone in their study had a right T-spine convexity.  They go onto say that the rotation of the body of the vertebrae in the T-spine are to the right.  Further, no significant rotation of the L-spine is noted and on top of that the upper T-spine (T-4 and up) is rotated back to the left.  Now that by itself is a good contradiction but not too worrisome since the study at least points out that “hey, everybody has a curvature”.  It even goes on to discuss the role of heart position and position of the aorta.  The real issue to me is not so much this study but the closer scrutiny that I place on our own positions.  Namely, we hold that, everyone is scoliotic but that pathos and non pathos have left rotated T-spine vertebrae but when we look at illustrations of NPS (Non Patho Compensatory Scoliosis) in the texts (see integration manual on curvature of the spine) we see right orientation just like the study I just discussed.  We, however, are stating opposite on most individuals.  This is a contradiction that needs to be cleared-up in my opinion.  Since most are NPS then this is a big deal to me unless I am missing something obvious.

“Rotation of the body of the vertebrate in the T-Spine are to the right” probably because of orientation of the spine to the right.  Therefore, if there in “no significant rotation of the c-spine, L4-L5” then the spine is beginning to compensate for this right orientation by moving L4-L5 to the left, to get to neutral, probably with the right psoas musculature and right quadratus lumborum.  This reflects the beginning stage of the patho-compensatory pattern.

The thoracic spine from T4 to T8 especially, does have a tendency, in my opinion, based on the number of x-rays I’ve seen of patients with a Left AIC / Right BC scoliotic pattern, to rotate to the left in a compensatory way.

The diagram in our integration manual, reflects what is so often seen, forces and thrust that are carried out on the spine to correct this right oriented rotation of the spine at the upper aspects of the thoracic and cervical level, which is also after palpated and seen on x-ray.  The T4 to T8 area central vertebral processes may be neutral (actual movement to the left on lower thoracic spine that’s oriented to the right) or may actually be rotated to the left slightly.  The right scalenes and cervical vertebrate are attempting to counteract this force and may also be neutral, often hyperflexed (flat cervical spine).  They are actually being rotated to the right to “pull up” the first two ribs during compensatory respiration via transverse processes.  As those two top ribs come up on the right, the spine appears straight or may be actively going to the right, with respect to the vertebrate rotation to the left, below.  This often leads to the T4 syndrome, theoretically, and a slight concavity at C6 to T3.

Another reason you see “pathos” and “non-pathos” with left rotated T spine “with both T4 to T8 arrows going to the left is because the center of gravity of both is to the right, however, to a lesser degree on the “pathos”.  There is probably less torque at T10 through L3 on the “pathos” because the force placed on the spine is reduced because of the longer C curve from L5 to T4 and less lateral concavity pressure at L1 to T10.

The right vs. left rotating T4 to T8 “contradiction” really depends on the individual.  But the forces depicted by the arrows in the manual best reflect, to my knowledge, what we see radiographically and clinically and recently as of last year, reinforced by Spine-Cor physicians at Sainte-Justine Hospital, I believe in New York.

Again, remember that just because you see right T4-T8 rotation on some individuals with a Left AIC – Right BC pattern doesn’t mean they don’t have the neuro-motor pattern.  Their substitution and compensatory mechanisms are different then what is clinically and radiographically seen.

One cannot ignore the fact that there is a rib flare on the left but if the right posterior ribcage is driven posteriorly by the rotated (right) vertebrae as illustrated then it would make sense to see a rib flare on the left anterior ribs. 

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