Left-sided scoliosis

A curved spinal column is a common problem, especially in schoolchildren. At the same time, there are many types of such curvatures - for example, if the spine bends to the left, then they talk about such a pathology as left-sided scoliosis. This type of pathology is more common than on the right, which is associated with a large percentage of right-handers who prefer to passively load the left side, since the right side is more functional for them. [1]

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

Epidemiology

Left-sided scoliosis for no apparent reason is most often found in childhood. According to statistics maintained by the American Physiotherapy Association, about every eight children out of a hundred in the age range of 9-14 years old develop a curvature of the spine. By the way, it is this period that is considered the most vulnerable for the development of scoliosis, since in adolescents the skeletal system at this time begins to grow rapidly. [2], [3]

As for the statistics of the causes of left-sided scoliosis, in 75-80% of cases they cannot be identified: in such a situation, the diagnosis is made of idiopathic curvature of the spine. [4], [5]

Causes of the left-sided scoliosis

The most common causes of left-sided scoliosis are:

• permanently unchanged position of the body (more often - forced);
• uncomfortable desk, incorrectly selected desk, etc.;
• lack of physical activity and associated weakness of the muscles of the back;
• carrying heavy loads on one shoulder or in one hand;
• trauma, congenital disorders. [6]

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

Risk factors

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

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

Pathogenesis

At birth, the human spine is characterized by total kyphosis: there is only one natural curvature, namely, the posterior bulge of the column. In the course of the growth of the baby and the formation of his muscles, the spine gradually acquires other bends. For example, when the baby begins to hold the head, cervical lordosis forms, and with the beginning of sitting, lumbar lordosis forms. The spinal column transforms within six to seven years, and already from this age one can suspect some postural disorders. [8]

Until puberty, the children's musculoskeletal system is actively growing and lengthening. To avoid the formation of left-sided scoliosis and other curvatures, the child is recommended to actively move, not to sit for a long time in one place. Correctly maintaining posture - this skill should be formed already in primary school age. [9]

From the age of twelve, the bones continue to grow rapidly, hormonal changes occur, which also affects the process of the 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, however, such violations account for no more than 10% of all such deformities. Basically, acquired disorders dominate, which are explained by the weakening of the muscles of the back and the anterior abdominal wall, when the "muscle tension" is incorrectly distributed. The uneven development of some muscles in comparison with others causes the appearance of deformities and the development of left-sided scoliosis. [10]

Symptoms of the left-sided scoliosis

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

The first signs are discovered by the patient himself much later - for example, when back pain appears after a short walk or a prolonged upright position. A person can often get tired back, it becomes difficult for him to sit for a long time on an ordinary stool: on a chair with a back, he feels more comfortable.

Scoliosis can be suspected if you look at yourself from the outside - for example, looking at photos or videos taken by friends. Characteristic features: different shoulder heights, a constant slope to one side. For many patients, standing up is uncomfortable. 

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 difficult: however, in many cases, the cause of its appearance cannot be determined.

In most children, the signs of left-sided scoliosis are not very pronounced, but they tend to progress. There are also known severe cases when the disease led to the 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 impaired. 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 your child's posture disorder?

• uneven shoulder position;
• protrusion of one blade in relation to the second;
• limping, a more elevated position of one hip in relation to the other.

If any sign is found, then you should not delay a visit to the doctor, even if the problem is not accompanied by painful sensations. It is best to take action ahead of time before the problem gets worse.

If in doubt, the following test can be performed:

• invite the child to bend over, lower his hands freely down;
• then you should look from behind at the back: in this position, the curvature becomes especially noticeable.

If curvature is present, then you need to think about conducting an X-ray study. [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 develops further, then the curvature may worsen and become complicated - for example, osteochondrosis, intervertebral hernia. To avoid problems, it is important to consult a doctor in a timely manner.

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

• Left-sided scoliosis of 1 degree is the minimum deviation not exceeding 10 °. However, many experts believe that almost every person has such a deviation, so it can be counted among the options for a healthy norm.
• Left-sided scoliosis of the 2nd degree is a deviation with indicators from 11 to 25 °. Such a violation already requires correction with the participation of an orthopedic surgeon.
• Left-sided scoliosis of grade 3 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 rarely recorded: in about 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 assumed that the idiopathic type of scoliosis may be related to a hereditary factor. [14]

Congenital curvature is provoked by a congenital defect of the spinal column. This can cause abnormalities in the development of the vertebrae. The problem manifests itself not from the moment of birth, but only from the age of 8-12, against the background of accelerated growth of the spinal column and an increase in the load on the "wrong" 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 vertebral curvature in segment III to VI of the vertebrae. Pathology, as a rule, is detected even in early childhood, and is dangerous for its complications. There is a risk of crushing 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, and 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 prolonged forced abnormal position of the trunk. Injuries and congenital disorders can also be “culprits”. Athletes acquire this type of pathology after muscle inflammation, accompanied by excessive stress on the thoracic spine.
• Left-sided thoracolumbar scoliosis is an aggregate term that characterizes the curvature of two segments of the spinal column at once, namely the thoracic and lumbar. The disease is often associated with damage to bone and cartilage tissue.
• C-shaped left-sided scoliosis (S-shaped) is characterized by the presence of two curvature arcs, which are called main and compensatory. The main arch is formed by a long-term initial incorrect load on the spine. And the compensatory arch (opposite bend) is the attempt of the spinal column to take a stable position. This curvature is usually smooth and covers different vertebral segments - for example, the thoracic and lumbar regions.
• Left-sided arcuate scoliosis - this term is usually called any arcuate curvature of the spine along the frontal plane, which is found in combination with torsion of the vertebrae. Torsion is a vertical twisting of the vertebrae, with their partial deformation and displacement in relation 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 difficult type of such curvature of the spine. The cause of the violation is the dysplasia of the lumbosacral vertebral region, so the arc usually passes, affecting the V lumbar and I sacral vertebra. Dysplastic scoliosis is characterized by hypermobility of the joints and the spinal column, sometimes by static flat feet. [15]

Complications and consequences

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

• dysfunctions of the respiratory and cardiovascular systems (curvature of the chest contributes to the compression of the lungs and heart, which causes shortness of breath and difficulty in the myocardium);
• regular back pain, even after minor exertion;
• improper posture, gait, changes in appearance adversely affect the child's self-esteem - often children begin to feel complexes, ashamed, which will certainly affect the psychological state.

Experts warn: left-sided scoliosis, which has developed in a baby before the age of five, with age has more chances to be complicated by a violation of the heart and lungs. The appearance of a curvature in adolescence is not so dangerous, but it can negatively affect the mental state and social behavior of a person. [16]

Diagnostics of the left-sided scoliosis

Routine examinations and screening tests are often performed in schools, manufacturing plants, and large offices. How to define left-sided scoliosis? The standard test is “bending over”: the person bends forward, the legs are held together, the knees are not bent, and the arms should hang down freely. Scoliosis is said to be when, during the test, a deformity is found 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 one hundred percent: it cannot be used to identify more than 15% of patients with scoliosis. Therefore, doctors are not limited to only one test: additional diagnostics are required. [18]

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

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

The degree of curvature is determined by the scoliograph. This instrument highlights the highest point of the upper curve of the back and measures the lateral (eg left-sided) curvature of the spinal column using a frontal plane imaging technique. The use of a scoliograph is an important stage, according to the results of which the doctor assesses the need for further X-ray examination. [20]

Standard instrumental diagnostics includes the following procedures:

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

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

Differential diagnosis

Differential diagnosis is carried out with right-sided scoliosis, with Scheuermann-Mau disease (progressive kyphosis-scoliosis curvature of the spinal column), with tuberculosis of the spine .

Treatment of the left-sided scoliosis

Drug treatment 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 the correction of the disorder.

Correction involves the use of such methods:

• wearing corrective, holding corset devices, belts;
• physiotherapy exercises, performing special exercises to correct the violation;
• massage, manual therapy to relieve muscle spasm, improve microcirculation and metabolism in tissues;
• physiotherapy;
• constant tracking of posture, movements.

Correction is performed regularly and for a long time: only hard work can restore a 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, however, physiotherapy in the treatment of left-sided scoliosis is indispensable. 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 applied all at once: the doctor can choose one or several procedures that are most suitable for a particular person. Consider the main methods for correcting posture with scoliosis:

• Electromyostimulation is the basic method for getting rid of muscle spasms, which are often present with curvature of the spine and are formed by pinching the nerve endings. Electrical impulses help relieve pain caused by local compression of the nerve endings by muscles in hypertension. In addition to left-sided scoliosis, electromyostimulation is actively used for osteochondrosis, spondylosis.
• Electrophoresis is a method of accelerating the entry of medicinal substances into the tissues of the body under the influence of galvanic current. The method is extremely effective, due to the properties of some components of the preparations, they ionize and penetrate deep into the layers of the skin, where their action lasts for 20 days. Along with this, there is no toxic effect of the injected drugs.
• Phonophoresis - improves blood circulation in tissues, relieves the inflammatory response in the affected area. Phonophoresis is characterized by a small number of side effects, especially when compared with taking muscle relaxants or injecting analgesics.
• Thermotherapy is a 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 (heating pads, paraffin, wax, ozokerite, dry air or electric light). Heat helps to improve blood 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 physiotherapy methods that has no contraindications, and, among other things, is quite effective. The created magnetic field has a positive effect on the blood flow in the area of the procedure, optimizes the restoration of damaged tissues.
• Laser treatment - involves the use of an amplified light beam consisting of UV, IR and red emitted spectrum. The procedure has anti-inflammatory and analgesic effects, helps to cope with edema, and speeds up metabolic processes.
• UHF therapy is a method using an ultra-high frequency field, which causes ionic vibration and the orientation of the dipoles of charged particles. The electrical potential is converted into heat, and the effect of high-frequency waves allows you to straighten the scoliosis curvature by relaxing the muscles and eliminating inflammation in the soft tissues. In addition, bioactive points in the body are involved, triggering its self-healing. [22]

Surgery

They talk about the need for surgical intervention if left-sided scoliosis is of the third or fourth degree - that is, with a strongly pronounced 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 playing sports. Typically, an implant is a titanium support system assembled from wires and staples that do not cause rejection and allergic processes.

Orthopedic surgeons are often faced with the need to perform interventions for resection of the vertebrae, the introduction of specific plates into the spine, and excision of adhesions. Surgical operation allows you to correct the position of the spine, fix the correct position of the vertebrae. [23]

Most of the operations are performed with the minimum possible intervention, without unnecessary trauma to the tissues. Correction is carried out with microsurgical manipulators through small punctures.

In some cases, to eliminate scoliosis in adulthood, autotransplantation is used: 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 advised to sleep mainly on the right side of the body, while bending the left leg at the knee. To make it more comfortable, you can put a pillow or a special orthopedic soft roller between your thighs or knees.

It is undesirable to lie on your stomach for a long time, but it is allowed to sleep on your back. True, you should not throw your arms up, as well as 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 vertebral segment should be parallel to the surface of the bed.

Exercise therapy for left-sided scoliosis

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

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

• teach correct posture retention, consolidate this skill;
• strengthen muscles, balance muscle tone;
• stabilize trophic processes in the muscles;
• correct and straighten the existing curvature.

Gymnastics with left-sided scoliosis is practiced in clinics, specialized exercise therapy dispensaries, preschool and school institutions (classes are held several times a week, at least 3-4 times). A standard full course of exercise lasts six to eight weeks. The courses can be repeated, but the break between them should be 4-5 weeks. With left-sided scoliosis, it is optimal to carry out 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 have a visual and physical idea of the correct posture, strengthen the preparation of the muscles for the load. The bulk of the exercise involves increasing the number of repetitions. Specific gymnastics is performed from facilitated positions: the patient lies on his back, stomach, squatting or kneeling. Passive rest between sets is required.

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

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

At the initial stage of treatment sessions, it is undesirable to practice:

• intense running;
• jumping long or high;
• hard landings;
• sitting exercise;
• exercises involving a wide range of motion.

Children under adolescence are not recommended to perform "hanging" on the crossbar: a sharp extension of the spinal column, as well as the muscle contraction that follows it, is more likely to harm than bring any benefit. Any sudden movement should be accompanied by subsequent 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 (classic type of massage);
• point;
• segmental.

Various types of massage are practiced both in specialized clinics of orthopedics and rehabilitation, and in oriental health centers. What does this treatment give? With its help, it is possible to stimulate blood circulation and establish 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 the known massage techniques, the most relevant are:

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

Stroking techniques are useful for pain relief and soothing effects.

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

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

Prevention

Low physical activity, prolonged incorrect position of the body, 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 particularly relevant in relation to children and adolescents.

In orthopedics, a number of preventive rules stand out, especially relevant for patients 6-7, as well as 12-15 years old. If measures are taken in a timely manner, it is possible to prevent or prevent the progression of the curvature.

• From infancy, it is necessary to pay attention to the fact that the child's bed is firm and even. 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 your baby in a hammock or on a soft feather bed.
• For the adequate development of the children's musculoskeletal system, it is necessary to provide him with regular physical activity, and also not to forget about walking, swimming, cycling.
• It is important to choose the right shoes for children.
• If the child sits at the table for a long time, at the desk, then he needs to be reminded every 30-40 minutes about the need to get distracted and take a break associated with motor activity.
• You need to pay attention to how the student carries a backpack, briefcase or bag. Up to about 10 years of age, it is optimal to carry a rigid backpack with a back (satchel). If the bag is worn on one shoulder, or worn in the hand, then it is necessary to regularly change the left and right side of wearing.
• The furniture used by the kid should be comfortable - both at school and at home. It is good if the table and chair are adjusted according to the height of the child.

If you follow the listed simple rules, then the physical development of children will be harmonious, correct posture will be developed, and health problems will decrease.

Forecast

School and industrial prevention programs involve early detection of most cases of scoliosis. This allows you to start treatment in a timely manner, without involving complex, including surgical methods.

Fortunately, most patients diagnosed with left-sided scoliosis are able to live a normal and fulfilling life. Women with scoliosis can conceive and give birth to a child, while 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 where the curvature is formed in the spinal column, at what stage it is, and how quickly it aggravates. The worst prognosis has a pronounced rapidly progressive left-sided scoliosis.