Scoliosis vs Levoscoliosis: What’s the Difference?

Scoliosis treatment needs to be individualized around key variables such as patient age and risk of curve progression, curve severity and pattern. A scoliosis X-ray is needed to determine the size and type of scoliosis because scoliosis can vary widely.

Scoliosis disrupts the spine’s healthy position by causing it to curve unnaturally to the side and twist. Most cases of scoliosis cause the spine to curve to the right, away from the heart, diagnosed as dextroscoliosis, but curves can also bend to the left: levoscoliosis.

A left-bending curve is atypical and can indicate an underlying pathology.

Levoscoliosis

Scoliosis causes an unnatural lateral spinal curve to develop, and because it also involves the vertebrae (bones of the spine) twisting unnaturally, it’s a complex 3-dimensional condition.

The progressive nature of scoliosis is a primary treatment challenge. The nature of scoliosis is to increase in severity over time, and in children, it’s growth spurts that trigger progression, and in adults, it’s declining spinal health that contributes to the onset and/or progression of adult scoliosis.

The most common type of scoliosis is idiopathic scoliosis with no single-known cause, and this accounts for the majority of diagnosed cases. Types of scoliosis with known causes include neuromuscular scoliosis and degenerative scoliosis.

In most typical cases of idiopathic scoliosis, the curve pattern is bending to the right, away from the heart, known as dextroscoliosis, but the spine can also curve towards the heart, known as levoscoliosis.

Because most curves bend to the right, when I see a left-bending curve on an X-ray, I know the cause isn’t idiopathic, and likely has an underlying pathology contributing to its onset and progression.

Levoscoliosis vs Dextroscoliosis: Main Differences

As mentioned, typical cases of idiopathic scoliosis involve right-bending curves, and a left side pattern is atypical.

Most cases of scoliosis involve dextroscoliosis with a curve pattern that protects the heart by bending in the opposite direction.

There are three main spinal sections, and scoliosis can develop in any one section, or in more than one in cases of a double curve scoliosis where two unnatural curves develop in opposing directions.

Most cases of dextroscoliosis develop in the thoracic spine: the largest spinal section that refers to the middle/upper back, and thoracic levoscoliosis can also develop.

Most cases of levoscoliosis develop in the lumbar spine (lower back), and while levoscoliosis describes a left-bending curve, and dextroscoliosis is the opposite, symptoms are similar.

Symptoms of Levoscoliosis

When scoliosis develops, it’s disrupting the spine’s healthy position and balance, and because the spine is the body’s central anchor, its health and position can affect the health and alignment of the entire body.

Symptoms are shaped by a number of key factors including patient age, type (cause), severity, and the main spinal section affected.

Symptoms of levoscoliosis are the same as symptoms of typical dextroscoliosis. In children, the main scoliosis effects involve postural changes caused by the spine’s unnatural curve and twist disrupting the body’s overall symmetry.

Uneven shoulders and hips are usually the earliest signs of scoliosis in children, and as a progressive condition triggered by growth, a child’s growth spurts can cause rapid progression, and thoracic curves are also the most prone to rapid advancement.

As posture changes alongside progression, increasing asymmetries such as uneven shoulder blades, a rib cage arch, an uneven waistline, and arm- and leg-length discrepancies may develop, and changes to mobility can become an issue as balance, coordination, and gait may also be affected.

Adult scoliosis includes postural changes, but the primary symptom of adult scoliosis is pain.

Scoliosis isn’t always painful, particularly cases of childhood scoliosis. A main cause of scoliosis pain is compression, and because scoliosis doesn’t become impressive until a skeletal maturity is reached, children don’t often experience compressive and/or radiating pain.

Scoliosis pain can also involve the spine’s surrounding muscles and supportive structures, and many adults aren’t diagnosed until radiating pain develops due to nerve compression.

Diagnosing Levoscoliosis

Diagnosing scoliosis isn’t always easy, particularly in cases of mild scoliosis that have subtle effects.

Because levoscoliosis has an underlying cause and is considered atypical, it can be more complex to treat, and diagnosis involves a comprehensive assessment to confirm the spine’s unnatural curve, rotation, and its size.

A minimum Cobb angle of 10 degrees is needed to be considered a true scoliosis, and in addition to curve size, X-ray results are needed to determine the spine’s pattern, rotational component, and a patient’s bone age can indicate potential curve progression.

Diagnosing levoscoliosis includes determining its underlying cause so treatment plans can be designed accordingly and invasive surgical treatment may be avoidable.

Levoscoliosis Causes

Not all cases of levoscoliosis are caused by neuromuscular conditions, but it is a common complication and needs a comprehensive treatment plan that focuses on addressing the neuromuscular condition as the underlying cause.

In cases of levoscoliosis caused by degenerative changes to spinal health, this usually affects older adults experiencing age- and/or lifestyle-related spinal degeneration. Many patients’ spinal degeneration starts with the intervertebral discs.

The spinal discs sit between vertebrae and give the spine structure, support, flexibility, and shock absorption. If one or more spinal discs are changing shape due to degenerative changes, they can become less functional, and the position of vertebrae attached may be affected.

Because the lumbar spine is load-bearing, its vertebrae can become stressed, and this is the most common spinal section affected by degenerative scoliosis.

Cases of degenerative levoscoliosis are often painful and usually progressive due to the spine’s increasing instability. While the spine is designed around movement, too much movement within the spine is problematic and dangerous, and puts older adults at risk of injury from a fall.

Diagnosing levoscoliosis includes determining its underlying cause, assessing its effects, potential curve progression, and individualizing treatment plans around these key details.

Levoscoliosis Treatment Options

Once the underlying cause of the levoscoliosis is determined, a treatment plan can be designed, but needs to be crafted by a specialist who understands the complexities of treating a progressive 3-dimensional spinal condition.

In cases of neuromuscular scoliosis with left-bending curves, it’s the underlying neuromuscular condition (cerebral palsy, muscular dystrophy, or spina bifida) that’s caused the scoliosis to develop as a secondary complication, and in these types of cases, the cause of the scoliosis has to be addressed and directs the course of treatment.

In cases of degenerative scoliosis with left-bending curves, the spine’s increasing instability has caused the spine to curve unnaturally to the left, and treatment needs to focus on improving body posture and the spine’s stability for fall prevention.

Postural collapse is a leading cause of disability in older adults, and while adolescent idiopathic scoliosis is the most common type overall, the rate of scoliosis increases among the aging population due to degenerative changes to spinal health and function.

As we age, muscles and ligaments can weaken, contributing to a lack of support for the spine, and a postural lean too far forward or too far to the side further contributes to adverse spinal tension.

With poor posture, asymmetrical loading occurs, and this can cause uneven wear and degeneration, initiating a cycle that can get worse over time; the goal is early detection so intervention can stop the cycle from forming.

Treatment for degenerative levoscoliosis focuses on restoring healthy posture so the spine is held in a straighter position, pain relief, increasing stability, improving function, and preventing further progression.

Lower back pain is a primary symptom of lumbar levoscoliosis, but with a proactive treatment plan, including scoliosis-specific physical therapy, Chiropractic BioPhysics®, activity modification and bracing, if necessary, and pain management, improvements to quality of life are within reach, and it’s never too late to start treatment.

Conclusion

Scoliosis causes the spine to develop an unnatural lateral spinal curve that rotates, and a typical curve pattern is to the right, protecting the heart and space around it, but in cases of levoscoliosis, the spine curves unnaturally to the left, towards the heart.

Dextroscoliosis and levoscoliosis have similar effects: postural changes, mobility changes, muscular imbalance, and pain.

Here at the Scoliosis Center of Utah, treating scoliosis involves individualized nonsurgical plans shaped around a number of important patient and scoliosis factors, one of which is curve pattern.

When curves bend to the right, these are typical patterns, but when they bend to the left side, this is an atypical pattern that usually has an underlying cause. Treatment options include scoliosis-specific rehabilitative exercise, chiropractic care, corrective bracing, and lifestyle guidance.

Restoring balance and alignment to the spine and strengthening its surrounding muscles for uniform support can improve the spine’s stability, body posture and appearance.