Playing with Richard's Spine

When I finish this email, I'll upload the results Skye and I got playing
with Richard's spine in Photoshop. She has further comments to make from an
anatomical POV, and I'll send these along once she's done.

We were unable to use the high resolution photo that Sandra found because
the photographer who shot it was likely standing at the bottom of the table
where they were laid out, rather than shooting from above the bones. This
created proportional distortion to the upper vertebra. Basically, this
means:

1. We needed to see the front edges of each vertebrae to be able to clearly
see/identify the wear patterns on each. This is because each edge's wear
pattern matches the corresponding wear pattern on the vertebrae above/below
it like puzzle pieces interlock. Richard has a lot of wear patterns, which
develop when vertebrae rub against one another due to the curvature of the
spine. This equals pain, because in a spine not affected by scoliosis (or
undamaged in other ways), the vertebrae do not grind against one another.

2. The distorted angle of shooting the photo resulted in the hard edges at
the bottom of many of Richard's thoracic vertebrae (from his waist upward)
visually merging with the inside walls of the vertebrae. So I couldn't see
the bottom edge clearly enough to match it with the top edge of the next.
(Bottom edge mushy + Top edge clean = Can't see through the mush to match
the edges)

I went looking for head-on shots of the vertebrae (did anyone shoot photos
of these bones from above them?) and discovered that each time they've been
laid out, the spacing between the vertebrae and the tilt of the vertebrae
have been different. In no photo that I can locate has the spacing between
the vertebrae been anatomically accurate, reflecting the actual space taken
up by the discs between each vertebrae.

Since the vertebrae are three-dimensional objects laid on a flat (table)
surface, they roll in position. This basically means each shot is not
consistent with any other shot, nor are any of them an accurate
presentation of the shape of Richard's spine.

I found a photo (with not the greatest resolution, unfortunately) that
*mostly* let us see clearly the top and bottom edges of each vertebrae.
This meant we could see the wear patterns at the top and bottom of each, so
we could match them like puzzle pieces one to the next.

What we saw was terrible wear on many of the vertebrae in his lower back as
they rubbed together during life (which caused the patterns to form). This
sort of wear also causes lower back pain as the "discs" between the
vertebrae are worn away. You then have bone-on-bone, vertebrae-on-vertebrae
contact at any number of points -- something that is again evident in the
wear patterns at the top and bottom of each.

The photo Sandra provided is good for seeing this wear if you enlarge it
and look at the edges of the vertebrae in Richard's lower back. As you move
farther up his spine, the bottom edges become blurred with the interior of
the vertebrae, so it's difficult to compare those particular bottom edges
with the top edges of the next vertebrae.

I'm looking forward to the future papers promised by the pros analyzing his
spine, but since Skye pointed out the wear patterns and told me what they
mean, I know now that it's not going to be easy reading for those of us who
can empathize with Richard's pain. Undamaged spines have clean edges, and
their bones don't wear one against the other. Richard's edges are worn in
some places and jagged in others, indicating bone- on-bone contact since
the wear above is reflected in the wear below.

As Carol said, we desperately need a 3D scan of each vertebrae, for a
qualified osteopathic surgeon to line them all up and present a
professional medical analysis of them. Until that happens, everyone is
playing in the dark.

~Weds