Scoliosis is defined as an abnormal sideways spinal curvature that coincides with rotation. Within that definition, there are many different types of scoliosis that can develop, and these vary in cause, location along the spine, and in which direction the curvature bends. The term ‘dextroscoliosis’ specifies that the abnormal curvature bends to the right, which is a typical form of scoliosis with the curve bending away from the heart.
Scoliosis is not a simple condition. It’s not simple in terms of understanding causation as its most common form is classed as ‘idiopathic’, meaning no known single cause, and it’s not simple in terms of treatment. This is partially because of how much the condition varies case to case. Let’s start our exploration of dextroscoliosis by discussing the factors that can make one case differ widely from the next.
When a condition is first diagnosed, part of that official diagnosis is to classify the condition by specifying its most important characteristics. When it comes to scoliosis, this process is especially important as successful treatment necessitates a customized approach.
Let’s also be clear that by ‘successful treatment’, I mean reducing the curvature and working to sustain that reduction. As a progressive condition with no known cure, the treatment goal is to manage its progression and stay ahead of its nature to worsen over time.
Progression is the big factor in managing scoliosis. We can’t cure it, but we can treat it. While there’s no one-size-fits-all formula that can be applied to determine just how fast, or slowly, a condition is going to progress, there are variables that indicate likely rates of progression.
This leads us to the first big factor in classifying scoliosis: age of patient.
Age of Patient
The age of the patient doesn’t just give us an idea of their overall health and fitness level; it also tells us what likely rate of progression we are going to be dealing with.
As mentioned earlier, one of the biggest challenges with treating scoliosis is trying to stay ahead of a patient’s progression, and as that rate can vary greatly from patient to patient, this involves a lot of monitoring.
As we know that growth is the number one trigger for progression, we know that forms of scoliosis that affect younger people with lots of growth and development to go through are the likeliest to face rapid progression.
The condition’s most common form that makes up 80 percent of diagnosed cases is adolescent idiopathic scoliosis, diagnosed between the ages of 10 and 18.
In adults, we know that scoliosis progression tends to slow down as they’ve reached skeletal maturity and that big progression trigger has been removed.
When classifying the condition, the age of the patient tells us the likeliest rate of progression we’ll be monitoring for, and we frame our treatment approach accordingly.
The next big classification point is the type of scoliosis, meaning cause, if known.
Type of Scoliosis
We’ve talked about the condition’s most common form, adolescent idiopathic scoliosis, and we know this type of scoliosis has no known single cause; that’s the ‘idiopathic’ classification.
There are, however, other forms of the condition with known causes, although they only make up the remaining 20 percent of diagnosed cases: congenital, neuromuscular, degenerative, or traumatic.
In each of these forms with known causes, scoliosis develops as a secondary complication of a more serious medical issue, condition, or trauma.
If a case is classified as one of these types, we know that the underlying issue that has caused the scoliosis to develop has to be addressed, and these forms also have their own progression and treatment factors.
Another big classification point is condition severity, and this is determined by what’s known as the Cobb angle.
Perhaps the most important classification point is condition severity. This is determined by measuring the patient’s Cobb angle via a scoliosis X-ray. This measurement helps us classify the condition as mild, moderate, or severe.
The measurement is taken from the most-tilted vertebrae at the apex of the curve, and it tells us just how far, in degrees, a patient’s spine deviates from a healthy alignment.
Mild scoliosis: Cobb angle measurement of 25 degrees or less
Moderate scoliosis: Cobb angle measurement between 25 and 40 degrees
Severe scoliosis: Cobb angle measurement of 40+ degrees
The thing with scoliosis is that as a progressive condition, it’s virtually guaranteed to get worse. Once we classify the condition’s severity, we plan our treatment plan accordingly and design our approach.
In addition to age of patient, type of curvature, and severity, where along the spine the scoliosis develops is also important.
The spine is divided into three main sections: cervical (upper spine and neck), thoracic (middle back), and lumbar (lower back).
Scoliosis that develops at different locations along the spine can produce different symptoms and indicate what a patient’s likely experience of living with their condition will be.
If scoliosis develops in the upper back, it’s classified as cervical. The thoracic spine is the most common site for scoliosis development, and scoliosis in the lower spine would be classified as lumbar scoliosis.
These designations tell us just where our treatment efforts need to be concentrated. Another important curvature characteristic takes us into defining dextroscoliosis.
Now, we know scoliosis is an abnormal sideways curvature of the spine that measures at more than 10 degrees and coincides with rotation. We also know that the condition’s type and location along the spine is important. Another factor that informs our treatment approach is determined by which direction the curvature bends.
A curvature that bends to the right, away from the heart, is known as dextroscoliosis, and this is considered ‘typical’ scoliosis. When a curvature bends to the left, towards the heart, this is known as levoscoliosis, is considered ‘atypical’, and warrants a different treatment approach.
When it comes to treating dextroscoliosis vs. levoscoliosis, the big difference is the red flag I see when I approach a case of levoscoliosis. As curvatures that bend to the left are atypical, I know that there is likely another pathology at work contributing to or causing the scoliosis.
I know that my first treatment step will be to address the presence of another pathology and treat it accordingly, and sometimes, this involves a referral to a specialist in the primary medical issue. Once that primary issue is diagnosed and assessed, we can then focus on how to move forward with treatment and how to address the scoliosis structurally.
So in terms of curvature location, if a patient’s condition is classified as ‘lumbar dextroscoliosis’, we know their curvature has developed in the lumbar spine and curves to the right; if a patient’s condition is classified as ‘thoracic dextroscoliosis’, we know their curvature has developed in their thoracic spine and curves to the right.
Once a condition has been classified by comprehensively reading the patient’s scoliosis X-ray, I know everything I need to effectively treat the condition.
For example, if a patient has dextroscoliosis of the thoracic spine, I know that this is a typical case of scoliosis with no underlying pathology to address prior to initiating active treatment.
As mentioned, in typical scoliosis cases, such as adolescent idiopathic dextroscoliosis, there is no known single cause which is why it’s classed as ‘idiopathic’. We know that growth and development and how it exerts tension on the spinal cord plays a role in causation, but the general consensus is that idiopathic scoliosis is multifactorial, meaning caused by multiple factors that vary from patient to patient.
With this form and location, we know that a rib deformity, if not already present, is a likely symptom to appear with progression. Depending upon the patient’s age and Cobb angle, symptoms will vary.
Generally speaking, the more severe the condition is, the more noticeable symptoms it will produce. These would include changes to posture and gait. An overall asymmetry to the body is the main cosmetic change that people with scoliosis notice as shoulders appear uneven, a rib deformity can emerge, and clothing can hang unevenly.
When it comes to dextroscoliosis and pain as a symptom, this doesn’t commonly become an issue until adulthood, once skeletal maturity has been reached. With the condition’s most common form that develops in adolescence, growth is a constant factor, and that lengthening motion of the spine counteracts the compressive force of the curvature. When growth is no longer a factor, the spine and its surrounding nerves and muscles become vulnerable to compression.
Based on the classification points, we design our customized conservative treatment approach. Here at the Scoliosis Reduction Center, our patients have access to multiple treatment disciplines in one convenient location. This is one of the reasons our treatment success rates are so high: because each and every patient gets a fully customized approach with the benefit of different forms of treatment.
Our main treatment tools include scoliosis-specific chiropractic, therapy, rehabilitation, and corrective bracing. Based on the condition’s characteristics and severity, we apportion each discipline accordingly. As we monitor progression, we tweak the plan and adjust the disciplines as needed in order to stay ahead of progression and achieve a curvature reduction.
Once we achieve a reduction and have addressed the structural issue of the deformity first and foremost, we work on maintaining those results and working with our patients to ensure they are sustainable.
When it comes to treating and understanding scoliosis, knowing the different forms the condition can take and how it’s classified tells us important characteristics.
Age of patient, type of curvature, location, and condition severity are factors that inform the roadmap for treatment. Here at the Scoliosis Reduction Center, we customize each and every treatment plan to address the individual characteristics of the patient and their condition.
Dextroscoliosis means the abnormal spinal curvature bends to the right, which is a typical case as it bends away from the heart. This means we can initiate an active conservative treatment plan as close to the time of diagnosis as possible so as not to waste valuable treatment time.