Left-sided scoliosis

A curved spine is a common problem, especially among schoolchildren. There are many types of such curvatures - for example, if the spine bends to the left, then we speak of such a pathology as left-sided scoliosis. This type of pathology is more common than on the right, which is due to the large percentage of right-handers who prefer to passively load the left side, since the right side is more functional for them. [ 1 ]

What do you need to know about left-sided scoliosis and how can you correct the curvature?

Epidemiology

Left-sided scoliosis without an apparent cause is most often detected in childhood. According to statistics kept by the American Physical Therapy Association, approximately every eight children out of a hundred develop spinal curvature between the ages of 9 and 14. Incidentally, this period is considered the most vulnerable to the development of scoliosis, since the skeletal system of adolescents begins to grow rapidly at this time. [ 2 ], [ 3 ]

As for the statistics of the causes of left-sided scoliosis, in 75-80% of cases it is not possible to identify them: in such a situation, a diagnosis of idiopathic curvature of the spine is made. [ 4 ], [ 5 ]

Causes left-sided scoliosis

The most common causes of left-sided scoliosis are:

• prolonged, unchanged position of the body (usually forced);
• an uncomfortable desk, an incorrectly selected school desk, etc.;
• lack of physical activity and associated weakness of the back muscles;
• carrying heavy objects on one shoulder or in one hand;
• injuries, congenital disorders. [ 6 ]

Most often, severe curvature is found in patients suffering from poliomyelitis, cerebral palsy, osteoporosis, rickets, connective tissue diseases, osteomyelitis, and metabolic pathologies. [ 7 ]

Risk factors

Left-sided scoliosis can develop under the influence of the following factors:

• various diseases such as rheumatoid arthritis, muscular dystrophy, poliomyelitis, cerebral palsy;
• history of organ transplantation, kidney, liver, and heart surgery;
• weak or, on the contrary, too intense physical activity;
• joint weakness, obesity;
• delayed sexual development associated with impaired growth of the musculoskeletal system;
• playing sports that involve excessive or one-sided stress on the spinal column (tennis, hockey, gymnastics, shot put or hammer throw, etc.);
• spinal and rib injuries, traumatic brain injuries, spinal cord injuries;
• neurological and muscular disorders, myopathies.

Pathogenesis

At birth, the human spine is characterized by total kyphosis: there is only one natural curvature, namely, the posterior convexity of the column. As the baby grows and its muscles develop, the spine gradually acquires other curves. For example, when the baby begins to hold up its head, cervical lordosis is formed, and with the beginning of sitting, lumbar lordosis. The spinal column is transformed over the course of six to seven years, and already from this age, some posture disorders can be suspected. [ 8 ]

Before puberty, the child's musculoskeletal system actively grows and lengthens. To avoid the development of left-sided scoliosis and other curvatures, the child is recommended to move actively and not sit in one place for a long time. Maintain correct posture - this skill should be formed already in primary school age. [ 9 ]

From the age of twelve, bones continue to grow rapidly, hormonal changes occur, which also affect the process of formation of the spine. Unfavorable conditions in the form of hypodynamia, prolonged stay in an uncomfortable position can cause the development of problems, including left-sided scoliosis.

There is also the concept of congenital curvatures, but such disorders make up no more than 10% of all such deformations. Basically, acquired disorders predominate, which are explained by the weakening of the muscles of the back and anterior abdominal wall, when the "muscle tension" is not distributed correctly. Uneven development of some muscles compared to others causes the appearance of deformations and the development of left-sided scoliosis. [ 10 ]

Symptoms left-sided scoliosis

Left-sided scoliosis often does not manifest itself in any way. With a small degree of curvature, the problem may not be noticed even by others, including the child's parents. Only in some cases does excessive stooping, constant tilt of the head to one side, protruding shoulder blades located at different heights attract attention. A person with scoliosis usually leans more on one side, and one shoulder may be higher than the other.

The first signs are detected by the patient himself much later – for example, when back pain appears after a short walk or a long vertical position. A person’s back may often get tired, it becomes difficult for him to sit for a long time on a regular stool: he feels more comfortable on a chair with a back.

Scoliosis can be suspected if you look at yourself from the outside - for example, looking at photos or videos taken by friends. Characteristic signs: different shoulder heights, constant tilt to one side. For many patients, trying to stand up straight causes discomfort.

Left-sided scoliosis in children

Scoliosis with left-sided curvature of the spine is most often diagnosed in childhood, when the child is growing rapidly. It would seem that the problem is not so complicated: however, in many cases, the cause of its occurrence cannot be determined.

In most children, the signs of left-sided scoliosis are not very pronounced, but they tend to progress. There are also severe cases when the disease led to immobilization of a person. For example, if severe scoliosis excessively limited the space of the chest, then the function of the entire respiratory system was disrupted. As a result - not only back pain, but also shortness of breath, cardiac disorders. [ 11 ]

What should you pay attention to in order not to miss a posture problem in your child?

• uneven shoulder placement;
• protrusion of one shoulder blade in relation to the other;
• limping, a higher position of one hip in relation to the other.

If any sign is detected, you should not delay a visit to the doctor, even if the problem is not accompanied by painful sensations. It is better to take measures in advance, before the problem worsens.

If in doubt, the following test can be performed:

• ask the child to bend over and let his arms hang freely down;
• Next, you should look at the back from behind: in this position, the curvature becomes especially noticeable.

If there is a curvature, then you need to think about conducting an X-ray examination. [ 12 ]

Stages

Moderate left-sided scoliosis at the initial stage of development is rarely detected even by the patient himself, since he does not feel any discomfort. However, if the pathology continues to develop, the curvature may worsen and become complicated - for example, by osteochondrosis, intervertebral hernia. To avoid problems, it is important to consult a doctor in a timely manner.

The magnitude of curvature of the spinal column varies: depending on this, several stages, or degrees, of left-sided scoliosis are distinguished:

• Left-sided scoliosis of the 1st degree is a minimal deviation, not exceeding 10°. However, many experts believe that almost every person has such a deviation, so it can be classified as a healthy norm.
• Left-sided scoliosis of the 2nd degree is a deviation with indicators from 11 to 25°. Such a disorder already requires correction with the participation of an orthopedic doctor.
• Left-sided scoliosis of the 3rd degree is assigned if the left deviation of the spinal column relative to the axis is 26-50°.

There is also a fourth degree of pathology, in which the curvature exceeds 50°. Both the third and fourth stages of left-sided scoliosis are extremely difficult to treat, but such cases are registered infrequently: approximately 10% of all patients with scoliosis. [ 13 ]

Forms

First of all, there are such types of left-sided scoliosis as idiopathic, congenital and neuromuscular.

Idiopathic pathology is found in the vast majority of cases: this term means that the cause of the problem could not be found. It is possible that the idiopathic type of scoliosis may be related to a hereditary factor. [ 14 ]

Congenital curvature is caused by a congenital defect of the spinal column. This can cause abnormalities in the development of the vertebrae. The problem does not manifest itself from the moment of birth, but only from 8-12 years, against the background of accelerated growth of the spinal column and increased load on the "incorrect" vertebrae.

Neuromuscular curvature is a consequence of back injuries, neurological pathologies, cerebral palsy, poliomyelitis, dystrophic processes in the muscles, myopathies, etc.

Among other things, there are other types of left-sided scoliosis:

• Left-sided cervical scoliosis is a spinal curvature in the segment from III to VI vertebrae. The pathology is usually detected in early childhood and is dangerous due to its complications. There is a risk of compression of the vertebral artery and cerebrovascular accident.
• Left-sided lumbar scoliosis is formed in the lower - lumbar - part of the back. It often becomes a consequence of rickets, rheumatoid arthritis, various endocrine diseases. It happens that this type of pathology is the initial sign of osteochondrosis, or the development of an intervertebral hernia.
• Left-sided thoracic scoliosis is a curvature in the thoracic spine, which is often formed as a result of a long-term forced incorrect position of the body. Injuries and congenital disorders can also be the "culprits". Athletes acquire this type of pathology after muscle inflammation, accompanied by excessive load on the thoracic spine.
• Left-sided thoracolumbar scoliosis is a collective term that characterizes the curvature of two segments of the spinal column at once, namely, the thoracic and lumbar. The disease is often combined with damage to bone and cartilage tissue.
• C-shaped left-sided scoliosis (S-shaped) is characterized by the presence of two arcs of curvature, which are called the main and compensatory. The main arc is formed by a long-term initial incorrect load on the spine. And the compensatory arc (opposite bend) is an attempt by the spinal column to take a stable position. Such curvature is usually smooth and covers different vertebral segments - for example, the thoracic and lumbar regions.
• Left-sided arcuate scoliosis – this term usually refers to any arcuate curvature of the spine along the frontal plane, which is found in combination with vertebral torsion. Torsion is a twisting of the vertebrae vertically, with their partial deformation and displacement relative to each other. These disorders often cause functional disorders of the cardiovascular and respiratory systems, and the digestive tract.
• Dysplastic left-sided scoliosis is the most complex type of such curvature of the spine. The cause of the disorder is dysplasia of the lumbosacral spine, so the arc usually passes, affecting the 5th lumbar and 1st sacral vertebrae. Dysplastic scoliosis is characterized by hypermobility of the joints and the spinal column, sometimes - static flatfoot. [ 15 ]

Complications and consequences

Even with unexpressed development of left-sided scoliosis, complications may develop. We are talking about such troubles:

• dysfunction of the respiratory and cardiovascular systems (curvature of the chest contributes to compression of the lungs and heart, which causes shortness of breath and difficulty in the functioning of the myocardium);
• regular back pain, even after minor exertion;
• incorrect posture, gait, and changes in appearance have an adverse effect on a child’s self-esteem – children often begin to feel inferior and ashamed, which inevitably affects their psychological state.

Experts warn: left-sided scoliosis that developed in a child before the age of five has a greater chance of being complicated by heart and lung problems with age. The appearance of curvature in adolescence is not so dangerous, but it can negatively affect a person’s mental state and social behavior. [ 16 ]

Diagnostics left-sided scoliosis

Preventive examinations and screening tests are often performed in schools, manufacturing plants and large offices. How to determine left-sided scoliosis? The standard test is a "tilt": the person bends forward, legs are held together, knees are not bent, and arms should hang freely down. Scoliosis is said to be present when the test reveals a deformation along the spine, an incorrect position of the shoulder blades relative to the axis of the back. [ 17 ]

Despite the popularity of the testing procedure, it is not 100%: it fails to identify more than 15% of patients with scoliosis. Therefore, doctors do not limit themselves to just one test: additional diagnostics are required. [ 18 ]

The need for treatment is determined only after the patient has undergone a full range of diagnostic procedures.

The physical test involves measuring the strength of the lower limbs and the quality of balance. The doctor evaluates the difference in leg length, checks neurological symptoms and the quality of reflexes, as well as muscle performance. [ 19 ]

The degree of curvature is determined by a scoliograph. This device identifies the highest point of the upper curve of the spine and measures the lateral (for example, left-sided) curvature of the spinal column by obtaining an image from the frontal plane. Using a scoliograph is an important step, based on the results of which the doctor evaluates the need for further X-ray examination. [ 20 ]

Standard instrumental diagnostics includes the following procedures:

• X-ray is one of the main diagnostic methods for detecting left-sided scoliosis and monitoring the dynamics of the process. X-ray clearly demonstrates the stage of the pathology, allows detecting other problems in the spine and assessing the degree of its development.
• Magnetic resonance imaging is no less informative than X-rays, but it is much more expensive. In addition to scoliosis, MRI can detect problems with the spinal cord.

Laboratory tests are not considered essential in diagnosing left-sided scoliosis. However, for general information about the patient's health, the doctor may order general clinical blood and urine tests, or a comprehensive blood test.

Differential diagnosis

Differential diagnostics are carried out with right-sided scoliosis, with Scheuermann-Mau disease (progressive kyphotic-scoliotic curvature of the spinal column), and with tuberculosis of the spine.

Treatment left-sided scoliosis

Medication is used only for organically caused left-sided scoliosis - for example, with a spinal injury, with tuberculous curvature. If the scoliosis is functional, then not treatment is carried out, but correction of the disorder.

Correction involves the use of the following methods:

• wearing corrective, supporting corset devices, belts;
• therapeutic exercise, performing special exercises to correct the disorder;
• massage, manual therapy to relieve muscle spasms, improve microcirculation and metabolism in tissues;
• physiotherapy;
• constant monitoring of posture and movements.

The correction is carried out regularly and over a long period of time: only hard work can restore the healthy position of the spine, and this requires patience and considerable willpower. [ 21 ]

Physiotherapy treatment

Gymnastics and exercise therapy are effective in their own way, but you can't do without physiotherapy in the treatment of left-sided scoliosis. Physiotherapy improves metabolism and blood circulation, stops the development of inflammation, and stabilizes muscle tone.

There are many physiotherapeutic methods recommended by specialists for patients with left-sided scoliosis. Of course, they are not all used at once: the doctor can choose one or several procedures that are most suitable for a particular person. Let's consider the main methods for correcting posture in scoliosis:

• Electrical myostimulation is a basic method for relieving muscle spasms, which are often present in spinal curvature and are formed due to pinching of nerve endings. Electrical impulses help relieve pain caused by local compression of a nerve ending by muscles in hypertonicity. In addition to left-sided scoliosis, electrical myostimulation is actively used for osteochondrosis and spondylosis.
• Electrophoresis is a method of accelerating the penetration of medicinal substances into the body tissues under the influence of galvanic current. The method is extremely effective, due to the properties of some components of the drugs to ionize and penetrate deep into the layers of the skin, where their effect continues for 20 days. Along with this, there is no toxic effect of the administered medications.
• Phonophoresis – improves blood circulation in tissues, relieves inflammation in the affected area. Phonophoresis has few side effects, especially when compared to taking muscle relaxants or injecting analgesics.
• Thermotherapy is a whole range of physiotherapy methods that use heat for therapeutic purposes – both from a natural and artificial source. Heat can be wet (baths or showers, compresses, etc.) and dry (hot water bottles, paraffin, wax, ozokerite, dry air or electric light). Heat helps improve blood flow and lymph flow, enhance metabolic processes, form bioactive substances and accelerate tissue regeneration. In general, a pronounced anti-inflammatory, analgesic and antiseptic effect is manifested.
• Magnetotherapy is one of the natural physiotherapeutic methods that has no contraindications and, among other things, is quite effective. The magnetic field created has a positive effect on blood flow in the area of the procedure, optimizes the restoration of damaged tissues.
• Laser treatment – involves the use of an enhanced light beam consisting of UV, IR and red emitted spectrum. The procedure has an anti-inflammatory and analgesic effect, helps to cope with swelling, accelerates metabolic processes.
• UHF therapy is a method using an ultra-high frequency field, which causes ionic oscillation and orientation of charged particle dipoles. The electric potential is converted into thermal potential, and the influence of high frequency waves allows for the correction of scoliosis curvature by relaxing muscles and eliminating inflammation in soft tissues. In addition, bioactive points in the body are activated, triggering its self-healing. [ 22 ]

Surgical treatment

The need for surgical intervention is discussed if left-sided scoliosis is of the third or fourth degree - that is, with a severe curvature.

In most cases, the operation involves the installation of all kinds of metal stable or dynamic implants, which are made of high-quality and reliable alloy. The installed structures do not have a negative impact on a person's usual way of life and do not become a contraindication to sports. Usually, an implant is a supporting titanium system assembled from spokes and brackets that do not cause rejection or allergic processes.

Orthopedic surgeons often face the need to perform interventions regarding vertebral resection, insertion of specific plates into the spine, and excision of adhesions. Surgery allows for correction of the position of the spine and fixation of the correct position of the vertebrae. [ 23 ]

The majority of operations are performed with minimal possible intervention, without excessive tissue trauma. Correction is performed with microsurgical manipulators through small punctures.

In some cases, autotransplantation is used to eliminate scoliosis in adults: the patient’s own bone elements (ribs, parts of the femur) are used to correct the spinal column. [ 24 ]

How to sleep with left-sided scoliosis?

Patients with left-sided scoliosis are recommended to sleep mainly on the right side of the body, with the left leg bent at the knee. To make it more comfortable, a pillow or a special orthopedic soft bolster can be placed between the hips or knees.

It is not advisable to lie on your stomach for a long time, but sleeping on your back is allowed. However, you should not throw your arms up, nor place them behind your head.

For a comfortable sleep and prevention of back pain, it is better to choose a high-quality hard or medium-hard mattress, as well as an orthopedic pillow. When choosing bedding, it is important to remember that during sleep, the cervical spine segment should be parallel to the surface of the bed.

Exercise therapy for left-sided scoliosis

Exercises for left-sided scoliosis should be performed at least three or four times a week. If you do not adhere to this regimen, physical therapy will be ineffective, and it will not be possible to restore normal posture. In general, patients are advised to pay attention to such sports activities as swimming, intensive walking, running. Swimming is especially recommended for left-sided scoliosis, since being in water reduces the load on the spine, stabilizes the condition of the intervertebral discs. [ 25 ]

What can exercise therapy do for patients with left-sided scoliosis:

• teach how to maintain correct posture and reinforce this skill;
• strengthen muscles, balance muscle tone;
• stabilize trophic processes in the muscles;
• correct and straighten the existing curvature.

Gymnastics for left-sided scoliosis is practiced in clinics, specialized exercise therapy clinics, preschools and schools (classes are held several times a week, at least 3-4 times). A standard full course of exercises lasts from six to eight weeks. Courses can be repeated, but the break between them should be 4-5 weeks. For left-sided scoliosis, it is optimal to conduct 2-3 treatment courses annually. [ 26 ]

At the beginning of the course of treatment, specially selected exercises with a small number of repetitions are used. The patient should develop a visual and physical idea of the correct posture, and the muscles should be prepared for the load. The main part of the exercises involves increasing the number of repetitions. Specific gymnastics is performed from easier positions: the patient lies on his back, stomach, squats or kneels. Passive rest between approaches is mandatory.

What exercises should not be done with left-sided scoliosis?

Physical exercises are indicated for almost all patients with left-sided scoliosis, since exercise therapy is considered the only method for truly effective strengthening and training of the muscular corset, and correction of tone. [ 27 ]

At the initial stage of therapeutic exercises it is not advisable to practice:

• intense running;
• long jump or high jump;
• hard landings;
• exercises in a sitting position;
• exercises that provide a wide range of motion.

Children under adolescence are not recommended to perform "hanging" on the horizontal bar: a sharp extension of the spine, as well as the subsequent muscle contraction, will rather harm than bring any benefit. Any sharp movement should be followed by relaxation, unloading. This is especially true for exercises on the spine.

Massage

To get rid of left-sided scoliosis, several types of massage are used:

• therapeutic (classical type of massage);
• point;
• segmental.

Various types of massage are practiced both in specialized orthopedic and rehabilitation clinics and in eastern health centers. What does this treatment give? With its help, it is possible to stimulate blood circulation and improve the activity of the central nervous system, improve the conduction of nerve impulses, normalize metabolic processes, and optimize the work of internal organs.

Among all known massage techniques, the most relevant are:

• stroking (from superficial to deeper);
• light and intense tapping;
• light and intensive rubbing and kneading;
• vibration elements.

Stroking techniques are good for pain relief and have a calming effect.

Deeper stroking movements improve nerve conduction, but are not suitable for patients with severe muscle spasms and severe back pain.

Rubbing techniques help to quickly improve blood circulation in a certain area. And superficial kneading helps to eliminate mild pain.

Prevention

Low physical activity, prolonged incorrect body position, improperly organized workplace - such factors in almost all cases lead to pathological changes in posture, diseases of the musculoskeletal system, as well as left-sided scoliosis. The problem is especially relevant in relation to children and adolescents.

In orthopedics, a number of preventive rules are distinguished, especially appropriate for patients aged 6-7, as well as 12-15 years. If measures are taken in a timely manner, it is possible to prevent or not allow the progression of curvature.

• From infancy, it is necessary to pay attention to the fact that the child's bed is hard and flat. As for the pillow, it may not be there at all, or it will be small: the child's head should lie parallel to the bed. You should not put the baby in a hammock or on a soft feather bed.
• For adequate development of the child's musculoskeletal system, it is necessary to provide him with regular physical activity, and also not to forget about walking, swimming, and cycling.
• It is important to choose children's shoes correctly.
• If a child sits at a table or desk for a long time, then he needs to be reminded every 30-40 minutes about the need to take a break and take a break associated with physical activity.
• It is necessary to pay attention to how the student wears a backpack, briefcase or bag. Up to about 10 years of age, it is optimal to wear a hard backpack with a back (school bag). If the bag is put on one shoulder or carried in the hand, then it is necessary to regularly change the left and right side of wearing.
• The furniture that the child uses should be comfortable – both at school and at home. It is good if the table and chair are adjustable depending on the child’s height.

If you follow these simple rules, your children's physical development will be harmonious, correct posture will develop, and there will be fewer health problems.

Forecast

School and industrial preventive programs imply early detection of most cases of scoliosis. This allows treatment to begin in a timely manner, without resorting to complex methods, including surgical ones.

Fortunately, most patients diagnosed with left-sided scoliosis are able to live a normal and full life. Women with scoliosis can easily conceive and give birth to a child, and men can engage in professional activities and even many sports. However, all of these people always have a high risk of back pain - for example, when walking or standing for a long time, as well as during pregnancy. [ 28 ]

In general, the prognosis largely depends on which part of the spinal column the curvature has formed, at what stage it is, and how quickly it worsens. The worst prognosis is for severe, rapidly progressing left-sided scoliosis.