How come such a healthy young man's body became crooked?

This is the 3311th article of Da Yi Xiao Hu

Xiao Wang is a programmer who usually sits all day staring at the computer to write code. One day, he bent over to move a box in the office, and suddenly his buttocks and the back of his thighs were throbbing like electric discharge. When the pain was slightly relieved, Xiao Wang stood up from the chair, but found that his body was crooked and his shoulders were not at the same height. Xiao Wang thought he had a stroke or a spinal fracture, so he rushed to the emergency room of Zhongshan Hospital. After carefully asking about his medical history and physical examination, the doctor diagnosed Xiao Wang with lumbar disc herniation. Lumbar magnetic resonance imaging confirmed that Xiao Wang had lumbar disc herniation in the 4th and 5th vertebrae.

In fact, this is a common symptom of patients with lumbar disc herniation, which is medically called "compensatory scoliosis". In order to relieve pain, patients with lumbar disc herniation take posture compensation, which results in scoliosis. The symptom is the lumbar spine bending to the left or right.

Lumbar disc herniation compresses the lumbar nerve roots and causes compensatory scoliosis

(Source: Spine Structure, Function and Disease, Science and Technology Press, 2020)

The protruding nucleus pulposus stimulates and compresses the nerve roots, causing low back pain and pain and numbness in the lower limbs. In order to relieve the pain, the body takes a self-protective action to relieve the compression of the nucleus pulposus on the nerve roots through lumbar scoliosis, which is a postural compensatory deformity. The direction of scoliosis is closely related to the position of the protruding disc and the compressed nerve roots. When the nucleus pulposus protrudes on the outside of the nerve roots (superior shoulder type), the upper body bends to the healthy side, and the lumbar vertebrae bulges to the affected side to relax the compressed nerve roots; when the protruding nucleus pulposus is on the inside of the nerve roots (axillary type), the upper body bends to the affected side, and the lumbar vertebrae bulges to the healthy side to relieve pain.

The scoliosis direction of suprascapular lumbar disc herniation: bending toward the healthy side will alleviate the symptoms, while bending toward the affected side will aggravate the symptoms.

The scoliosis direction of axillary lumbar disc herniation: bending toward the healthy side aggravates the symptoms, while bending toward the affected side relieves the symptoms.

Usually, this compensatory scoliosis is reversible, and as the pressure on the nerve roots is relieved, the scoliosis will slowly return to normal levels. Lumbar scoliosis has auxiliary diagnostic value, but it is not a specific sign of lumbar disc herniation. If a person who usually has no crooked body suddenly finds that his body is crooked, accompanied by back and leg pain, lumbar disc herniation should be highly suspected.

Another condition that causes body crookedness is scoliosis. The most common types of scoliosis are idiopathic scoliosis and degenerative scoliosis. However, this type of scoliosis does not appear suddenly, but develops gradually. Idiopathic scoliosis is common in children and adolescents, and parents or teachers often find that their children have spinal curvature, asymmetric waist and back, and high and low shoulders. Degenerative scoliosis is more common in the elderly, and may be accompanied by shorter height, back pain, and even lower limb pain and numbness. It is a change caused by aging of the spine. "Razor back" is a more characteristic manifestation of severe scoliosis. When the patient bends over, the asymmetry of the chest on both sides can be seen from the back. This is also a relatively simple examination method.

In severe scoliosis, the ribs on the convex side bulge backwards, forming a "razor back" deformity.

(Illustration: Frank H. Netter)

Therefore, if you find that you have grown crooked, there is no need to overthink it. You should go to the hospital for further evaluation to find out the cause so that you can receive targeted treatment.

Author: Li Juan Lin Hong

Instructor: Dong Jian

Unit: Department of Orthopedics, Zhongshan Hospital Affiliated to Fudan University

Institute of Medical Science Popularization, Fudan University

This article was funded by the following project: Shanghai Science and Technology Commission Science Popularization Project

(No.: 20DZ2312000)

Shanghai Municipal Health Commission Outstanding Academic Leader Project

(No.: GWV-10.2-XD11)