The human spine should appear straight when viewed from the back. When the spine develops an abnormal side-to-side curvature, the condition is known as scoliosis. Levoscoliosis is a specific subtype where the spinal column bends toward the left side of the body. This leftward curve often prompts medical investigation, as it can sometimes indicate an underlying condition more readily than a right-sided curve.
Defining Levoscoliosis
Levoscoliosis is characterized by a lateral, or sideways, curvature of the spine that projects to the left, often forming a “C” shape in the torso. This leftward bend differentiates it from dextroscoliosis, which involves a curve to the right.
The severity of the curvature is quantified using the Cobb angle, a measurement taken from an X-ray. The angle is determined by drawing lines along the most tilted vertebrae at the top and bottom of the curve, and then measuring the angle at which they intersect. A Cobb angle measurement of 10 degrees or greater is the established threshold for a formal scoliosis diagnosis. Based on this measurement, the condition is categorized as mild (10 to 25 degrees), moderate (25 to 40 degrees), or severe (over 40 degrees).
Identifying the Causes
The origin of levoscoliosis is categorized into three main groups. The most common form is idiopathic levoscoliosis, meaning it has no identifiable cause and typically develops during adolescence. Approximately 80% of all scoliosis cases fall into this idiopathic classification.
Congenital levoscoliosis results from malformations of the vertebrae that occur during fetal development. This type involves structural abnormalities, such as vertebrae that are misshapen, fused, or not fully formed, causing an initial imbalance in the spinal column. Neuromuscular levoscoliosis arises as a secondary condition to disorders affecting the nerves and muscles. Conditions like cerebral palsy or muscular dystrophy can lead to an imbalanced pull or lack of control over the muscles supporting the spine, causing it to curve.
Recognising the Signs and Symptoms
In its milder forms, levoscoliosis may present with few outward signs, often going unnoticed until a medical screening. The most common visible symptom is an asymmetry in the body’s posture and alignment, such as uneven shoulders or a noticeable difference in hip height.
The condition can also cause a slight protrusion of the shoulder blade or a rib hump on one side. This asymmetry becomes particularly apparent during the Adam’s forward bend test. While mild cases are often painless, more significant curves can cause chronic back pain or muscle fatigue as the body strains to compensate for the spinal imbalance. In severe cases, the curvature can reduce the space available for the lungs, potentially leading to difficulty breathing.
Diagnosis and Treatment Options
Diagnosis begins with a thorough physical examination where a clinician assesses the patient’s posture and checks for signs of asymmetry. The Adam’s forward bend test is standard, as it highlights any rotational deformity. If scoliosis is suspected, the next step is a standing X-ray of the entire spine to confirm the curve and calculate the Cobb angle.
Imaging studies are crucial because the Cobb angle dictates the course of treatment. An MRI or CT scan may be ordered if the curve is atypical, rapidly progressing, or if there is suspicion of an underlying structural cause, such as a tumor or syrinx.
Treatment Strategies
Treatment strategies are tailored to the patient’s age, the severity of the curve, and the likelihood of its progression.
For mild curves (under 25 degrees), management involves observation with regular follow-up appointments and X-rays every four to six months.
If the curve is moderate (typically 25 to 40 degrees in a growing adolescent), bracing is often recommended to prevent progression. A custom-fitted brace is worn daily to provide external support and guide the spine’s growth.
Surgical Intervention
Surgical intervention is reserved for severe curves, typically those exceeding 40 or 45 degrees, especially if they are progressing rapidly. The most common procedure is spinal fusion, which permanently joins two or more vertebrae together. This is achieved using bone grafts and metal instrumentation, such as rods and screws, to correct the curvature and stabilize the spine.