Dextroscoliosis refers to a condition in which the spine curves to the right. When this curvature occurs in the lumbar or lower back region, it is termed dextroscoliosis of the lumbar spine. This article explores the causes and diagnostic considerations for dextroscoliosis of the lumbar spine, providing insight into its underlying mechanisms and associated symptoms.
What is Dextroscoliosis?
The term “dextroscoliosis” combines “dextro,” meaning right, and “scoliosis,” meaning a sideways curvature of the spine. Thus, dextroscoliosis describes a spinal curve that veers to the right. This condition is distinct from levoscoliosis, where the curve goes to the left. In the lumbar spine, dextroscoliosis indicates a right-sided curvature in the lower back.
Typical Patterns in Spinal Curvature
In children, scoliosis tends to follow predictable patterns based on the body’s anatomy.
- Thoracic Spine: The body naturally resists curves to the left in the upper back (thoracic region) because the heart occupies that side of the chest. As a result, scoliosis in this area often curves to the right.
- Lumbar Spine: Conversely, scoliosis in the lower back often curves to the left, forming levoscoliosis.
These patterns serve as protective mechanisms, particularly in children. However, when a dextroscoliosis occurs in the lumbar region or a levoscoliosis in the thoracic spine, it raises concerns about potential underlying neurological conditions.
Neurological Conditions Associated with Dextroscoliosis
Atypical scoliosis patterns, such as dextroscoliosis in the lumbar spine, may be linked to three primary neurological issues:
1. Chiari Malformation Type 1
Chiari malformation occurs when the brainstem extends below the base of the skull. Normally, the brainstem should sit entirely above the foramen magnum—a large opening at the skull’s base. An extension of the brainstem into this region may exert pressure on the spinal cord, leading to neurological symptoms.
Symptoms of Chiari Malformation Type 1:
- Loss of abdominal reflex
- Headaches
- Numbness or tingling in the hands
- Muscle weakness
- Stiffness or abnormal walking patterns
Diagnosis: MRI imaging is essential to detect Chiari malformation. Radiologists measure the extent of brainstem protrusion below the foramen magnum. Any abnormal extension is noted and evaluated for its impact on spinal curvature.
2. Syringomyelia
Syringomyelia refers to the presence of a fluid-filled sac, called a syrinx, within the spinal cord. This condition often coexists with Chiari malformation and may exacerbate symptoms.
Symptoms of Syringomyelia:
- Muscle weakness
- Numbness in the extremities
- Pain or stiffness in the back
Diagnosis: MRI imaging also helps identify the presence of a syrinx, enabling healthcare professionals to assess its influence on the spinal cord and curvature.
3. Tethered Cord Syndrome
Tethered cord syndrome occurs when the spinal cord’s fibers become abnormally attached to the surrounding vertebrae. As a child grows, this tethering restricts the spinal cord’s movement, pulling the spine into an abnormal curve.
Symptoms of Tethered Cord Syndrome:
- Weakness in the legs
- Loss of abdominal reflex
- Back pain
Diagnosis: In cases where tethered cord syndrome is suspected, imaging studies are performed to confirm the diagnosis and assess the degree of nerve adhesion to the vertebrae.
Dextroscoliosis in Adults: De Novo or Degenerative Scoliosis
In adults, dextroscoliosis of the lumbar spine may develop due to age-related degenerative changes. This type of scoliosis, known as de novo or degenerative scoliosis, typically appears between 40 and 50 years of age. Unlike scoliosis in children, there is no consistent pattern of curvature direction in adults; it may curve to either the right (dextroscoliosis) or the left (levoscoliosis).
Key Differences in Adult-Onset Scoliosis:
- No Neurological Indicators: In adults, dextroscoliosis does not necessarily suggest underlying neurological issues.
- Location of Curvature: Degenerative scoliosis often occurs exclusively in the lower back, without affecting the thoracic spine or heart region.
The lack of involvement in the upper back means there is no predisposition for the curve to avoid the heart, unlike in children.
Diagnostic Approaches for Dextroscoliosis
Early and accurate diagnosis is crucial for managing dextroscoliosis effectively. The diagnostic process typically includes:
1. Physical Examination
A clinician may observe the patient’s posture, gait, and spinal alignment. Neurological symptoms, such as numbness or muscle weakness, are also evaluated.
2. Imaging Studies
- X-rays: These provide a clear view of the spine’s curvature and help measure its severity.
- MRI: Essential for identifying underlying neurological issues such as Chiari malformation, syringomyelia, or tethered cord syndrome.
3. Neurological Tests
Tests to assess reflexes, muscle strength, and sensation help determine whether the spinal curvature is linked to a neurological condition.
Treatment Options for Dextroscoliosis
The treatment of dextroscoliosis depends on the severity of the curve, its underlying cause, and the patient’s age.
- Observation: Mild cases, particularly those without neurological symptoms, may only require regular monitoring.
- Physical Therapy: Exercises to strengthen the core muscles and improve flexibility can help manage symptoms and prevent progression.
- Bracing: In growing children, bracing may be used to slow or halt curve progression.
- Surgical Intervention: In severe cases or those involving neurological complications, surgery may be necessary to correct the curvature or address underlying conditions such as tethered cord syndrome.
Conclusion
Dextroscoliosis of the lumbar spine, while common in adults with degenerative scoliosis, may indicate underlying neurological issues in children. Understanding the potential causes, including Chiari malformation, syringomyelia, and tethered cord syndrome, is essential for accurate diagnosis and effective treatment. By employing a combination of physical examinations, imaging studies, and neurological tests, healthcare providers can tailor interventions to address both the curvature and its root causes.
Also read: How to Identify Scoliosis Early
About:
Dr. Strauss is the director of the Hudson Valley Scoliosis Correction Center in New York. He has been actively engaged in scoliosis treatment for the past 30 years and has authored two books on the subject, Your Child Has Scoliosis and The Truth About Adult Scoliosis.
He is Vice President of the CLEAR Scoliosis Institute and a lecturer for their introductory and advanced workshops. He is certified in scoliosis bracing and in the use of scoliosis specific exercises. Dr. Strauss is a graduate of the ISICO World Masters of Scoliosis.His postgraduate studies also include a Masters Degree in Acupuncture as well as training in Grostic, Pettibon, CBP, Clinical Nutrition, Chinese Herbal Medicine, Manipulation under Anesthesia, and Electrodiagnosis.
His scoliosis practice has treated patients from 25 states and 32 other foreign countries.If you have questions about childhood and adult scoliosis and how it can be successfully treated without surgery subscribe to our channel!