In Episode 30, host Heather Rotunda and Dr. Alex discuss levoconvex scoliosis, its symptoms, and treatment.
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Hello, and welcome to Episode 30 of Life Beyond the Curve. I'm your host, Heather Rotunda. Back with me today is Dr. Alex Greaux, of the South Florida Scoliosis Center in Miami, Florida, to discuss Levoconvex scoliosis. Dr. Alex has been with CLEAR since 2011 and is both Standard and Intensive Care certified. In addition to his Doctorate in Chiropractic and Minor in Nutrition, he also holds a degree in Physical Therapy. I'm sure you'll enjoy this conversation with Dr. Alex and learn as much as I did. Episode 30, here we go!
You're listening to Life Beyond the Curve, a podcast brought to you by CLEAR Scoliosis Institute. Each week, we interview experts in the industry, answer your pressing questions, and empower you to take control of your scoliosis diagnosis and live life to its fullest. Enjoy the show.
Thank you for joining us today, Dr. Alex!
Hey, thanks for having me again. It's great to be here.
Today we're talking about levoconvex scoliosis. Now I've heard the terms, levo scoliosis and levoconvex scoliosis. Are those interchangeable terms, or is there a distinction with a difference?
Okay, so great question. So let's start first by defining, um, what that means. So the root word Levo means left, right? So when somebody says Levo, it is basically, they're saying it's a left side, right? When they say Levo convex, every curve has a Convex side and a concave side. So think of like a, a rainbow, right? So the top part of the rainbow would be called the Convex side and the underside of the rainbow would be called the concave side. So when they're talking about a scoliosis and they say a left or levoconvex scoliosis, that would indicate that the curve bends to the left hand side and protrudes out to that side. So the easiest way to understand is if somebody says levo it's left, if somebody says dextro it's right. Now, when you ask me, are they interchangeable? So levo scoliosis and levoconvex scoliosis are essentially saying the same thing. It bends to the left. You're just saying the top side of the rainbow is on the left side. So are they interchangeable? Yes, they are.
Okay. That was a very helpful analogy. I've read that about 80% of diagnosed cases of scoliosis are idiopathic, meaning they're not associated with a known cause. Do we know what causes levoconvex scoliosis?
Yeah. So let's, let's go back a little bit, right? So when we talk about a scoliosis, scoliosis, as we defined previously, is any type of, if we're looking from the spine from the front or, or, or, or back, any type of a bend one way or the other, right? So if I'm looking at you from the, the front or back, if it bends left, or bends right, that's a scoliosis, but you could have a C shaped curve. You could have an S shape curve where there's two curves. You can even have triple curves and I've even had curves that are four or five as well. Now, when you say, uh, a levo scoliosis, that usually sets off a, a red flag for people, right? Now, if you have an S-shaped curve, you're gonna have a dextro part of the curve. And you're gonna have a levo part of the curve, because if the curve is an S, while it curves to one side, and then it also curves to the other side. The key here is defining where that levoconvex scoliosis is or where, where that levo scoliosis is.
Because if it's in the lower back, you're not so concerned, but when it's in the thoracic spine or the dorsal spine, or you hear a levoconvex dorsal scoliosis, then you start to set the alarm bells off. Now that is the case where 80% of the, uh, diagnosed cases of scoliosis are idiopathic, the other 20% or part of those percentages when they go into it, one of the things that is the, the red flag is the left curve or the levoconvex curve. Why? So the typical presentation of a thoracic curve is it bends to the right hand side if I'm facing the person, right? So if I'm looking at the person, it bends to the right, okay. Now why would it not go to the left? So really simple question here. So everybody should know if you put your hand over your heart during the Pledge of Allegiance, they know that the heart is on that left side.
So, innately, if the curve bends to the left, there's a problem because the body's innate intelligence will cause the spine to bend to the right to avoid compromising heart function. Right? So when you see a left sided curve, that is not a normal curve when it goes to the thoracic side, because it's gonna start to put pressure against the heart. So immediately, if somebody sees, Hey, I've got this levoconvex scoliosis in the dorsal spine, those should be red flags for whoever the clinician is. Right? So, unfortunately, not a lot of doctors specialize in this, so they don't know to look for that. So I know you asked me a question that I kind of took down a rabbit hole, but we've kind of gotta define it. So if it's a left curve, levoconvex, and it's in the lumbar spine, we're not so concerned. If it's in the thoracic spine, then we start to get a little bit concerned. So again, I know I kind of ran around your question there, but that's the answer on as far as, uh, if it's left sided. So I wanted to go back and clear clarify that, cuz that's really important to know. If you're ever told you have a left side of thoracic curve, red flag, find somebody who knows what they're doing. It's really important.
Okay. So it's atypical to have that kind of curve. Uh, does that atypical nature affect the CLEAR treatment process? Or can you even answer that in a general way?
Yeah. So again, we're going to that point where, you know, I know I jumped because we were talking about idiopathic scoliosis and we had asked before about levoconvex, but there's a couple causes for a left sided curve, right? So, um, you could have, uh, what's called a syringomyelia, which is a, a fluid-filled tumor. You could have either a neuromuscular type condition, uh, where neuromuscular type of curves could be like a, uh, myelodysplasia, or a cerebral palsy or a Friedreich's ataxia. These curves are usually secondary to another type of condition. So there's something else going on, um, that could happen, right? So those are the ones that we have to really pay attention to. So when the question is asked, Hey, um, again, what are the types of curves? How do they happen? If somebody says levoconvex, we start to think of this red flag.
And usually when we do treatment, we just have to clear them, first of all, these other things, right? So it's knowing how to appropriately diagnose the condition and then the appropriate prognosis. So typically we're gonna do some additional testing. We might order some MRIs, we might do some genetic testing. We might run some blood tests, because again, we need to find out what is the cause of an abnormal curve, right? And if it's something that needs to be addressed in any other way, we will specifically address it that way. But our treatment is, first identify what is the cause of that left sided scoliosis. And then if it's something else, what else needs to be done? So I know that's a complicated, uh, rundown that I just gave you, but it's, it's a red flag and it's something that's really important people need to pay attention to.
Okay. So, out of curiosity, do you see more Levoconvex scoliosis patients in one age group over others?
No. So again, it's such a rare time when it happens. Um, we do get them, uh, you know, but they are a unicorn, meaning when people see it, it should, it should send off some signals. It should send off some red flags. And the key being is we have to make sure it's treated appropriately. So it's not that it's, uh, you know, you see it in adolescents or juveniles or, uh, anything like that. It's not a particular time period. It's just making sure that when you do know that the patient has a scoliosis, it's identifying, is it an abnormal presentation and why, and then if so, what needs to be done and what can be done.
Uh, we love to hear before and after stories here on Life Beyond the Curve. Is there one you could share with us of a patient whose levoconvex scoliosis you treated and what their experience and results were like?
Sure. I, like I said, we've got these, we get these all the time, right? And, um, whether it is, uh, some type of neuromuscular condition or just, it just happens to be a unicorn that's there and there's no issues. Um, to me, I have had some of these that, um, are neuromuscular and the neuromuscular cases are the ones that again are secondary to a condition. And again, just to run through, 'em the most common one being cerebral palsy. But if you have any type of SMA, which is spinal muscular atrophy or Friedreich's ataxia, or Duchenne's muscular dys-- excuse me, Duchenne muscular dystrophy, or even like a myelodysplasia. So those are the most common ones, but those are the ones that are the most difficult to deal with because usually there's all types of neurological issues, secondary as well, that are, that are being affected.
They might be in a wheelchair or they might have difficulty walking. Um, I did have a, uh, little girl that came to me from Israel, actually, that, uh, treated with me from the time she was six years old, actually. Uh, and now she's an adult. Um, but you know, she had a form of palsy that, again, it affected her gait, but I manage her whole condition, uh, or her whole scoliosis through her whole growth cycle, up to an adult. And it was really touching because, um, she was in a wheelchair at times, and then she walked with a walker at times. And, uh, it was a tough battle. You know, it was really emotional. Um, the mother, uh, and the daughter worked very hard and we all worked together. We all cried together. We laughed together, and we smiled together and, you know, I'm really happy to say she's a happy, healthy adult now.
Uh, and she's functioning well. Uh, but again, it's one of those things that it's appropriate treatment. You know, I, I like the cases that are complicated. They really tug at your heartstrings because you really affect somebody's life. Um, I mean, I cried with this one patient so much because it's, it was really challenging. And the improvements that we saw were amazing. And it's just, again, you're giving quality of life to an individual that has a lot of different things going on. And if I could help in the least bit, it's, it's just a world of difference. Like you sleep better, you're thankful every day for what you do. And, and we really enjoy it, right? It's not just, Hey, I'm running through this routine to help, uh, somebody with pain. It's it's, this patient has scoliosis. And this particular type of patient that I was talking about had a lot that they'd been through.
They'd had, I think, like, 15 surgeries by the time they saw me and they were six years old, you know, it's a lot to go through. Um, so that's the most touching, but you know what? Every single case has its own story because each person is individual, they're all amazing. And everybody has their own little thing. Kids that thought they were gonna have to have surgery that didn't, kids that thought they had to stop playing certain sportsand they didn't. Kids that, you know, were really upset or depressed and even suicidal because they're told they have this condition when really, it's just proper management. And that's what it comes down to. People need to understand, this is not the end of something. This is just, how do you start managing this properly? Because quality of life is all that we look for. It's making sure the person can function properly and not have an issue. So again, I can't say it enough. Early detection is the key. Every single curve is different. Once you get 'em, it's just doing the right thing and making sure it's managed properly.
Okay. Now I'm gonna throw, um, a question at you that's slightly off topic, but it's, um, something I see a lot. Um, patients who are looking for a CLEAR doctor and they check our website and they see that they don't have a CLEAR doctor near them and travel isn't an option. What would you recommend that they do in a case like that?
So it's tricky and it's, I can only say it because you have to give the patient, your child, your friend, the best possible chance of getting the best care. Right? Um, and I don't want to even imply that you could possibly do something else, but I'm gonna tell you that the first choice and only choice should be to find a CLEAR doctor. So if you can't get to them, start with a consult, meaning most offices will do a consult online, or they can call them. I'm happy to do it. You can, I can set up a Zoom or Skype or something, uh, which is very simple, you can find us on the website, uh, and just get to us directly. I'm happy to do it. We don't charge for it because it's that important to us that you get proper guidance and proper advice. Now I'm gonna tell you, you have to find somebody that knows what they're doing, because everything else is subpar.
You're not gonna get results. You're not gonna get changes. So let's say you live, uh, in the middle of the, the States and you can't get to somebody, um, drive, fly, do something. You know, we'll always work with patients because it means that much to us. A lot of us that are Intensive certified, you know, I can speak for myself, I've had people from Europe, from Asia, from Dubai, uh, you know, from all over the world that, that come in for treatment, because it's that important. So I would encourage you and urge you to know that this is a problem that needs to be addressed. And you know, the chiropractor down the street doesn't know what they're doing when it comes to this. The physical therapist doesn't know how to manage this. This isn't just a, oh, I have a little bit of pain. I'm gonna go see the average person.
You have to find somebody who's a specialist. So unfortunately you're kind of stuck in that position where I understand you can't get to somebody, but you gotta make it happen. You know, because if not, you're gonna regret it the rest of your life, you know? And that's not something that I sleep well with. I would tell you minimally get a consult done with one of the intensive doctors, have them set some time aside, I'm personally happy to do it. I know some of the other doctors do it as well, but it's just first figuring out what the condition is, how serious is the condition and how do you manage it properly? We'll give a recommendation. We'll give you recommendations of what we think by reviewing films, if you have 'em, or by going through things. But it's so important. I, I can't stress enough. Don't make the excuse that, oh, that person's too far. If you don't time this right, you will suffer. You know, you will have consequences that come with it. And it's just making sure that you do the best thing possible when you can, and you gotta really try and work hard to find an appropriate doctor that can manage the case properly.
Okay. That's, that's really helpful. Thank you so much for joining us again today, Dr. Alex, it's always a pleasure and we look forward to having you back on a future episode.
Yeah, thanks. Listen, I don't wanna leave it on a bad note. Right? I don't wanna make it sound that way, but the truth is like, you know, scoliosis is a condition that really is complicated. It's the most complex condition of the spine. Like, there is nothing more complex because of how many different variables there are. You gotta fight for yourself and get to the right doctors, because when they're trained properly, it'll mean the world, the difference to you. So I just wanna leave with those parting words. I'm happy to help out, any one of the CLEAR doctors can help. Uh, and again, thanks for having me, Heather. It was a pleasure as always.
Thank you. Have a great day.
Thank you. You, too.
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