There are a few different categories of curvatures of the spine, including levoscoliosis and structural scoliosis.
What is Scoliosis?
Scoliosis is a curved spine. It can be categorized by age: infantile (to age 3), juvenile (to age 9), and adolescent (to age 18). About 80% of the idiopathic cases of scoliosis fall into the adolescent category, a time when growth is rapid. The scoliosis curve can go to the right, as with dextroscoliosis in the thoracic spine, which is the more common curve. The curve itself might be a “C” or “S” shape. Left scoliosis, or levoscoliosis, is typically in the lumbar spine. It is rarely in the thoracic region, but if it is, it “may be secondary to a spinal cord tumor”. Scoliosis can also be described by location: thoracic (middle spine), lumbar (lower spine), or thoracolumbar (lower thoracic and upper lumbar). Idiopathic scoliosis is the most common type. Congenital scoliosis forms in utero and may need surgical correction. Neuromuscular scoliosis can be found in some people with conditions such as cerebral palsy or muscular dystrophy. Adult scoliosis is called degenerative, as “joints in the spine degenerate”.1
What Causes Scoliosis?
Most cases of scoliosis have no known cause (idiopathic), and many cases are diagnosed by the age of 7. Some cases are just mild scoliosis, while others are more serious. Spinal injuries, infections, birth defects (such as spina bifida), muscular dystrophy, and cerebral palsy are known potential causes of scoliosis. Family history may be a factor, and females “are more likely to have a more severe form”. Scoliosis pain is possible. Symptoms of the disorder include a shoulder blade being higher or sticking out more than the other, rotating spine, hips that are uneven, a spinal twist, pain in the back, or trouble breathing due to the chest area being reduced. There are a few ways to diagnose scoliosis, including a physical exam and imaging scans and tests.2 Some of the concerns regarding scoliosis have to do with “left curvature in the thoracic spine”, as is the case with levoscoliosis. The pressure on the ribs can affect the heart and lungs.3 Structural scoliosis, which tends to affect adolescent females and is often idiopathic, may be related to another disease, such as connective tissue disorders, birth defects, injury, infections, tumor, or arthritic, metabolic, or neuromuscular diseases. Structural scoliosis differs from functional or nonstructural scoliosis, where the spine curves, but is “structurally normal”.4 Functional scoliosis “a temporary change of spinal curvature”, typically caused by different leg lengths, inflammatory conditions, or muscle spasms. The spine itself does not need the treatment; however, the underlying condition does. This is how functional scoliosis differs from structural scoliosis, where the curve of the spinal bones is fixed.5
As mentioned before, dextroscoliosis is a form of scoliosis where the spine curves right. Typically, it impacts the middle back to upper back, known as the thoracic spine. This is the most common curvature, and it can form the shape of a “C”, or it can combine with another curvature to form the shape of an “S”. The opposite curve, levoscoliosis, goes to the left, but this usually affects the lower spine, or lumbar region. If it does occur in the thoracic spine, which is rare, it could be the result of a spinal abnormality or even a tumor in the spinal cord. General symptoms of scoliosis, other than the shoulder and hip heights or positions, are the head not being centered with the body, a difference in the ways that the arms hang, and the sides of the back appearing uneven when the patient bends over. In the more severe scoliosis cases, aside from the difficulty breathing, patients may experience back, chest, and leg pain, or even “changes in bowel or bladder habit with difficulty controlling…function”.6
Medical Treatment Options
If the patient is still growing, and the curve is over 30 degrees or getting worse between 20-29 degrees, or if the patient has 2 more years of growth or is female (prior to menstruation), the National Institute of Arthritis and Musculoskeletal and Skin Diseases recommends a back brace. While the brace “will not straighten the spine”, it “can prevent the curvature from increasing”. Spinal surgery for scoliosis, such as lumbar scoliosis surgery, might be necessary for patients with severe curves over 45 degrees. Spinal fusion is the surgical choice. Surgical risks include infection, pain, nerve damage, bleeding, and “failure to heal”.7 Levoscoliosis treatment options vary. In cases of mild scoliosis, they might correct themselves. Braces can help with posture, while the patient is still growing. Exercises are recommended for strength, although they “cannot help prevent the progression”.8
There are a variety of braces available to patients for scoliosis. Rigid braces include “Milwaukee brace, Jewett brace and Thoraco-Lumbar-Sacral Orthorsis (TLSO brace) or commonly called Boston brace”. The Milwaukee brace has bars that extend from the neck to pelvis, while the Jewett brace allows for “slight movement in backwards bending, but not forward bending”. The TLSO brace extends from the underarms to the pelvic area. Rigid braces can only slow or halt the progression of the scoliosis, but they cannot correct the curvature. They are also uncomfortable and not aesthetically pleasing, so compliance is an issue. There is another brace option: the SpineCor brace, which allows for “natural movements of the body”. It can be hidden under clothing and is “more comfortable”. The SpineCor brace has a pelvic base with elastic bands that “connect to the patient’s trunk” in a manner that is based on the type of scoliosis the patient has. It is said to correct the spinal deformity, improve posture, reduce pain and medications, lower the chances that the scoliosis will progress, and perhaps help the patient avoid surgery. The SpineCor brace, being more comfortable, could cause less “pressure point lesions”, and it might “reinforce the muscles”, unlike rigid braces, which “may cause muscle loss in the back”.9
Alternative Treatment Options
Frequent checkups can be helpful in monitoring the progression of scoliosis, and chiropractors are experts in musculoskeletal conditions. For patients with scoliosis pain, spinal manipulation, exercise, and electrical muscle stimulation could provide relief.10 In general, a chiropractor will form a specific treatment plan that includes “monitoring, chiropractic adjustments, at home exercises or a physical therapy program”. If the scoliosis has progressed to a “higher degree angle”, other options, such as bracing or surgery, may be considered due to concerns about health. A recent retrospective study of “28 adult scoliosis patients” found improvements in disability, pain, and Cobb angle, from “multimodal chiropractic rehabilitation treatment” after the treatment conclusion and for the next two years.11 The Cobb Angle is used to diagnose scoliosis. 10 degrees is the minimum to define the condition, and 15-20 degrees may not need interventions other than monitoring the condition.12 Massage also has benefits for functional and structural scoliosis. A recent case report found that massage relieves pain, improves sleep, and increases the “ability to conduct daily activities for people with scoliosis”. Sustained pressure and massage strokes, stretches, and positioning can “help balance the muscles of the back and body”. Patients can also improve their body awareness and learn how to “change movement habits that contribute to functional scoliosis”.13
Find out more about scoliosis and chiropractic.