Second opinion about x-ray of pelvis with 9mm lift
AP radiograph taken standing with 9mm heel insert on right side. Right side is on the right.
Dear Dr. Lewis,
I am hoping you will provide a second opinion about my recent x-ray; especially noting issues which might contribute to my low back pain and intermittent radiculopathy (beyond my L5-S1 disc herniation ca. 16 months ago).
In particular I am interested in your professional opinion about:
(1) the apparent twist in my lumbar vertebrae: could this contribute to low back pain? It seems to have gotten worse, in comparison with my x-ray from 16 months previous; any idea what might cause it and (if it is causing a problem) how it might be corrected?
(2) my right sacrum and sacroiliac joint: I am not really sure what is going on there--can you enlighten me? More of my (intermittent) sacroiliac pain is on the left side, which to me looks (more) normal.
(3) the length and angle of my femoral necks: Are they still within the range of normal human variation? Any evidence of a CAM or pincer deformity?
I also noticed that my acetabula are not quite even. Could any of these (or other) issues be making me sit or walk oddly?
Any other issues that you notice?
Thank you very much for your expertise.
The 9mm lift looks about right. If you went any higher it might help your back more, but then distort the pelvis. All things being equal, I'd stay at 9mm.
(1)You clearly have a lumbarisation of the S1 segment; it's a fairly common anomaly and they certainly give more trouble in my experience. It's hereditary, and one of the reasons that back pain runs in families. Your children should also being lower back exercises every day before arising from bed. Prevention is better than a cure; 50% of them will have trouble as bad as yours, or worse.
That twist certainly contributes to your back pain; the facets at L5/L6 and L6/S1 are asymmetrical, and no, it's not correctable; in fact the lift may have made them look worse. It would be interesting to compare with a view of the pelvis without the lift, also taken standing.
(2)There are question marks about the right SI joint. It could be ankylosis, or even infection, but you'll notice the sacrum is much wider on the right, almost 30% more. I suspect the unusual appearance of the right SI may be due to the gross rotation of the sacrum. A CT scan might be in order.
(3)The femoral necks do appear shortened but I think (uncertain, out of my scope) probably also related to the lift, or the way your were standing. No CAM, very tiny, probably insignificant pincers, but certainly early degenerative change in the left hip; caused by a lifetime of short leg, can't change that. Your children should be assessed at some stage to prevent this happening in their hips; a lift at an early stage is problematic with kids but certainly worth a consideration.
The right acetabular space above is within normal limits, but you are right, the medial joint space does appear lessened and hazy; is the left hip stiff, painful?
Remember, I'm not there to examine you, put all the pieces of your history together, SJ. Opinions from Professor Web should often be taken with a pinch of salt!
In short though, a 9mm short leg with a lumbarisation is always going to try both you and your chiropractor. Keep exercising, keep fit as you can, walk and swim, and don't move the deep freeze and grand piano.
I hope this contributes some.