When scoliosis is assessed and diagnosed, the process involves further classification based on a number of important factors: patient age, condition severity and type, and curvature location and type. These factors inform the customization of treatment plans.
Scoliosis can be challenging to treat not just because it ranges widely in severity, but also because there are different types with unique treatment needs. A diagnosis of levoconvex lumbar scoliosis means an unnatural sideways bending and rotating spinal curve that bends to the left has developed.
The diagnostic process for scoliosis is complex; there are a number of variables that need to be determined and X-ray results are necessary.
A healthy spine is key to overall health, and healthy spinal curves are key to spinal health and function.
The spine's healthy curves make the spine more flexible, better able to absorb and distribute mechanical stress, and stronger.
If the spine loses a healthy curve, as one long structure, the health of the entire spine can be disrupted.
Being diagnosed with scoliosis means an unnatural spinal curvature has developed, and the spine also rotates, making scoliosis 3-dimensional, and it needs to be addressed as such in treatment.
Diagnosing scoliosis involves a physical examination with an Adams forward bend test to screen for indicators of the condition, and if further testing is warranted, a scoliosis X-ray is ordered to fully see what's happening in and around the spine.
An X-ray is needed to confirm there is rotation and the size of the unnatural spinal curve: Cobb angle.
The higher a patient's Cobb angle measurement, the more misaligned the spine is, and the more severe the scoliosis.
Condition severity is a key factor treatment plans are designed around, and additional factors include the type of scoliosis and its location within the spine.
In many cases, a diagnosis isn't always easy to understand, especially when it comes to medical terminology, so let's break down the term levoconvex lumbar scoliosis.
So now that we know what it means to develop scoliosis and how it affects the spine, let's talk about curvature type and location.
There are different types of scoliosis curves, and a defining feature is the direction of the bend.
In a healthy spine, its vertebrae are aligned, but when some vertebrae become unnaturally tilted, they can shift out of alignment with the rest of the spine, causing it to bend unnaturally to the side.
Now in most cases of typical idiopathic scoliosis (cause unknown), curves bend to the right, so right-bending curves involve typical scoliosis cases, but there are also condition types that involve left-bending curves, and this is the levo portion.
Curve direction is important because it tells us whether or not we're dealing with a typical case or an atypical case caused by an underlying pathology: neuromuscular scoliosis, degenerative scoliosis, and congenital scoliosis.
The convex designation indicates that the curve's outer edge is on the left.
The last portion of the term lumbar references the location of the curve within the spine.
Scoliosis type is determined by causation, and while we don't know why most cases develop initially, we do know how to respond with treatment.
As mentioned, most cases of scoliosis have no known cause, and this involves typical cases of dextroscoliosis, and these cases are thought to be multifactorial: caused by a combination of factors.
But when the spine curves towards the heart on an X-ray, the abnormal curvature of the spine can be particularly severe due to an underlying pathology; scoliosis treatment has to account for this and determine the type in question.
Scoliosis with known cases that are associated with left-bending curves include neuromuscular scoliosis, degenerative scoliosis, and congenital scoliosis.
Neuromuscular scoliosis treatment is complex because another condition has caused the scoliosis to develop, and these cases can be difficult to treat as they can be particularly severe with some patients becoming unable to walk on their own and wheelchair bound.
Neuromuscular scoliosis can develop as a secondary complication of a serious neuromuscular condition like spina bifida, muscular dystrophy, or cerebral palsy.
Not everyone with a neuromuscular disease will develop scoliosis, but it is a common complication as neuromuscular conditions cause a disconnect between the brain, the spine, and the muscles and connective tissues that support the spine.
Degenerative scoliosis affects older adults over the age of 45 and is more common in females due to changes in bone density and hormones caused by menopause.
Degenerative scoliosis is the second most common type of adult scoliosis. It's caused by natural age-related spinal degeneration, and the cumulative effect of certain lifestyle factors can also play a role (obesity, low activity levels, chronic poor posture, etc).
Most spinal degeneration starts with the discs; as they deteriorate and change shape, this can cause vertebrae attached to a disc to change their position and the spine to lose its healthy curves and alignment.
Cases of degenerative scoliosis can be painful because the spine is becoming increasingly unbalanced, and unstable, and this puts older adults at risk of injury through a fall.
Congenital scoliosis is a rare type, affecting approximately 1 in 10,000.
This type develops in utero due to a bone malformation within the spine; some vertebral bodies can be more triangular in shape than rectangular: making it hard for the vertebrae to stack neatly on top of one another in a straight/neutral alignment.
Vertebrae that fail to form separately and instead fuse into one solid bone can also be problematic and cause an abnormal curvature to develop.
A patient's scoliosis diagnosis involves an initial assessment and X-ray results, and the information collected in these assessments is key to treatment success.
The more precise and comprehensive a patient's assessment and diagnosis, the more precise and customized potential treatment results can be.
The accuracy of these early assessments are crucial, otherwise treatment plans are designed around inaccurate information, which is why a scoliosis specialist is recommended for treatment; the complex nature of scoliosis is beyond the scope of general medicine and practitioners.
So once conditions are fully classified, treatment can begin; in fact, when it comes to progressive conditions like scoliosis, the timing of when treatment is started can be important.
A proactive response to a diagnosis can mean the potential to prevent progression and increasing condition severity.
So treatment plans are shaped around the classification points: patient age, condition severity, type, curvature type and location.
Here at the CLEAR Scoliosis Institute, a proactive conservative treatment approach combines the power of multiple scoliosis-specific treatment disciplines: chiropractic care, physical therapy, bracing when appropriate, and rehabilitation.
Through chiropractic care, the position of the curve's most-tilted vertebrae may be improved, and supporting the structural changes with increased core and back muscle strength is key.
Through physical therapy and scoliosis-specific exercise, the spine's surrounding muscles can be strengthened and balanced. A muscular imbalance can be a common symptom of scoliosis.
Corrective bracing can help by improving the spine's alignment and stability.
Lifestyle guidance and helping patients establish a home-rehabilitation program with scoliosis-specific exercise is also important for further healing the spine and sustaining long-term treatment results.
A diagnosis of levoconvex lumbar scoliosis means an unnatural spinal curve bends to the left, towards the heart, and rotates, and the outer edge of the curve is on the left.
As the scoliosis bends to the left, there is an underlying cause that has to be factored into treatment, and while some atypical cases can be particularly severe and recommended for spinal fusion surgery, the sooner conservative treatment options are started, the more potential there is for successful treatment results.
While no treatment results can ever be guaranteed, improvement can often be worked towards that impact a patient's quality of life, including complex cases of levoconvex scoliosis.
When it comes to symptoms of levoconvex scoliosis, because the scoliosis develops in the lumbar spine, it's the lower back and body that are the most affected; postural changes like uneven shoulders and uneven hips are common, as are disruptions to movement, and in adults, the main symptom of scoliosis is pain caused by compression.
While some cases of levoconvex lumbar scoliosis may require surgical intervention, invasive nonsurgical treatment has a number of benefits when it comes to long-term spinal health and function, and if diagnosed early, as a progressive condition triggered by growth, the best time to start treating all types of scoliosis is always now.
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