Understanding scoliosis begins with identifying its location and the type of spinal curvature.
Knowing this information can help predict what types of scoliosis symptoms may be experienced and how the condition can best be treated.
There are several detailed systems for classifying specific types of scoliosis curves, but some of the most common terms identify curves based on their location within the spine and the direction they bend.
Thoracic, lumbar, and thoracolumbar scoliosis all refer to location, while terms such as dextroscoliosis and levoscoliosis indicate whether the spine curves to the right or left.
Thoracic scoliosis describes curvature positioned in the middle, or thoracic, part of the spine. It is the most common location for scoliosis curves, and often includes deformity of the rib cage and spine. As the rib cage develops asymmetrically, one shoulder may become lifted or one leg may appear longer than the other.
Lumbar scoliosis occurs in the lower, or lumbar, part of the spine. It may cause one hip to appear higher than the other or one leg to appear longer than the other.
In some cases, lumbar scoliosis is degenerative, developing after age 50 due to a breakdown of the spine — as opposed to the more common adolescent idiopathic form, which presents no known cause. Those with degenerative lumbar scoliosis may exhibit no symptoms at all, or they may become severely disabled.
With thoracolumbar scoliosis, the curve includes vertebrae from both the lower thoracic and upper lumbar parts of the spine. It is often congenital, occurring in utero during the third to sixth week, and detectable at birth. It may even be the secondary effect of a neuromuscular condition (such as spina bifida or cerebral palsy).
Thoracolumbar scoliosis usually involves a curve toward the right and occurs more often in females than in males.
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Types of Scoliosis Spinal Curvature
The side view of the human spine has natural curves to help absorb the stresses of everyday movement. When viewed from the side, a healthy spine has gentle curves; when viewed from behind, it runs straight down the middle of the body. With scoliosis, the spine develops an abnormal sideways curvature that can range in severity from mild to severe. Other conditions may cause the spine to curve inward or backward.
Intro to the Anatomy of the Spine
The spine is comprised of 33 individual bones (including the pelvis), called vertebrae, which are stacked one on top of the other. The spinal column is part of the skeletal system which provides structure and support for the body while also enabling movement. Only the top 24 vertebrae are movable, and they are divided into three regions: cervical, thoracic, and lumbar. The sacrum is the set of five bones that, together with the iliac bones, make up the pelvis, while the coccyx region consists of four fused bones that make up the tailbone. Both the sacrum and coccyx are fused in place.
When viewed from the side, a healthy spine should have a natural “S” shape consisting of three natural curves. The cervical spine (the neck) and the lumbar spine (the lower back) both exhibit a slightly concave curve while the thoracic spine (the middle back) has a gentle convex curvature. The curves of the spine work almost like a coiled spring, compressing to absorb shock while still allowing a full range of motion throughout the spinal column.
Unfortunately, there are a number of ways the spine can develop an abnormal curve:
Dextroscoliosis is characterized by an abnormal sideways curvature of the spine that goes to the right, known as dextrocurvature. (When the spine curves to the left, it is called levoscoliosis.)
Dextroscoliosis is one of the more common scoliosis curvatures and, depending on the degree of severity, it gives the spine an “S” or “C” shape. This form of scoliosis typically affects the thoracic spine region and usually develops in children between the ages of 10 and 15 when they go through their first growth spurt. It can also be triggered by various muscle or connective tissue disorders later in life.
The symptoms of dextroscoliosis include uneven shoulder height, asymmetrical shoulder blade or rib prominence, uneven hips or waistline, and a noticeable curvature of the spine. In more severe cases, the abnormal curvature may cause the patient to tilt his or her head, or to lean the entire body to one side. Depending on the degree of curvature, dextroscoliosis can compress the organs, which can lead to problems with breathing and circulation. It may also cause pain in the chest, legs, or back.
Unfortunately, as many as 85% of scoliosis cases are idiopathic, meaning they have no known cause. In the other 15-25% of dextroscoliosis cases, the condition is either congenital, neuromuscular, or age-related. It can affect anyone, but it is most prominent in preteen and teenage girls.
Dextroconvex scoliosis is characterized by an S-like curvature of the spine, specifically in the lumbar region. This type of scoliosis is also known as lumbar dextroscolioisis or dextroscoliosis of the lumbar spine. When the curve is very slight, about 10 to 20 degrees, it is sometimes called mild dextroscoliosis. This term doesn’t refer to the severity of symptoms that may be associated with the spinal curvature; it refers to the degree of curvature in the spine.
Thoracic dextroscoliosis is characterized by an abnormal curvature in the thoracic region of the spine, in which it curves laterally to the right. As is true for lumbar dextroscolioisis, mild thoracic dextroscoliosis typically refers to a curvature 20 degrees or less on the Cobb angle measurement scale. Although this form of scoliosis can be mild, it may still cause pain and other symptoms. It is also possible for the curve to progress over time.
The opposite of dextroscoliosis, levoscoliosis is characterized by an abnormal sideways curvature of the spine that goes to the left, known as levocurvature. While this form of scoliosis typically affects the lumbar spine, it may affect the thoracic spine in some cases. When the thoracic spine becomes involved, it can compress the organs and lead to problems with the heart and lungs. In mild cases, levoscoliosis may not produce any symptoms and can potentially resolve on its own; in more severe cases, it may cause asymmetry with the shoulders and hips, as well as breathing problems. It isn’t usually a painful condition.
There is no specific cause for levoscoliosis, but in many cases, it is a condition present at birth (known as congenital scoliosis). It can also be secondary to various muscle and tissue disorders like muscular dystrophy.
Presence of levoscoliosis in the thoracic spine is often a strong indicator that a tumor is growing on the spinal cord. Diagnosis can be made using x-rays while MRI and CT scans can be used to determine the severity of the condition and its impact on the internal organs.
Levoconvex scoliosis, also known as thoracic levoscoliosis, affects the thoracic region of the spine and is characterized by an abnormal lateral curvature that goes to the left. As is true for other types of scoliosis, levoconvex scoliosis can range in severity from mild to severe, but the curvature is typically limited to the T1 through T12 vertebrae. Even so, this type of scoliosis has the potential to affect the rib cage and might cause compression of the organs, which can be dangerous. It is important to monitor levoconvex scoliosis for signs of progression.
The opposite of lumbar dextroscoliosis, lumbar levoscoliosis is characterized by an S-like curvature of the spine in the lumbar region. The curve affects the vertebrae in the lower back – L1 through L5 – and the curve itself goes to the left. Like dextroscoliosis, lumbar levoscoliosis is often mild, but it has the potential to progress over time – especially when it develops during childhood or early adolescence.
Determining a Course of Treatment
Scoliosis takes many different forms, and understanding the differences is important for determining the proper course of treatment.
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