What is the treatment for levoscoliosis?

Treatment for Levoscoliosis

The treatment for levoscoliosis depends on the curve severity, patient age, skeletal maturity, and risk of progression, with options ranging from observation to bracing to surgical correction based on specific criteria. 1

Diagnostic Evaluation

Before determining treatment, proper evaluation is essential:

• Complete spine radiographs (PA and lateral views) are the primary imaging modality for diagnosis, classification, and monitoring 1
• Cobb angle measurement to determine curve severity
• Assessment of skeletal maturity using the Risser index
• MRI may be indicated if there are risk factors for neural axis abnormalities, including:
  • Left thoracic curve
  • Short segment curve (4-6 levels)
  • Absence of apical segment lordosis
  • Rapid curve progression (>1° per month)
  • Functionally disruptive pain
  • Focal neurologic findings
  • Male sex
  • Pes cavus 1

Treatment Algorithm Based on Curve Severity

Mild Curves (<20°)

• Observation with radiographic follow-up
• For adolescents at Risser stages 0-3: radiographs every 12 months
• For adolescents at Risser stages 4-5: radiographs every 18 months 1
• Specific exercises may be beneficial (SEAS - Scientific Exercises Approach to Scoliosis) 2

Moderate Curves (20°-45°)

• Bracing is the primary non-surgical intervention
• Full-time bracing (23-24 hours/day) with gradual weaning
• Types include Risser cast, Lyon brace, or Sforzesco brace 2
• Continue specific exercises during bracing
• Monitor for curve progression every 4-6 months during growth periods

Severe Curves (>45°)

• Surgical correction with fusion is traditionally recommended 1, 3
• However, intensive bracing may be considered for patients who refuse surgery
  • Studies show that even curves 45°-60° can improve with proper bracing and high compliance 2
  • Reported improvements of 6°-9° in main curves with intensive bracing protocols 2

Special Considerations

Congenital Scoliosis

• Requires both radiographs and MRI for complete evaluation 1
• Higher risk of associated cardiac and renal abnormalities 3
• May progress more rapidly than idiopathic forms

Early-Onset Scoliosis (0-9 years)

• Requires both radiographs and MRI without contrast 1
• More aggressive monitoring due to higher risk of progression during growth
• May benefit from early intervention

Scoliosis in Specific Conditions

• In neurofibromatosis type 1, annual clinical evaluation with Adam's forward bend test is recommended 1
• Dystrophic scoliosis in NF1 typically presents in childhood and has more rapid curve progression 1

Surgical Decision-Making

Surgical intervention is typically considered when:

• Thoracic curves exceed 50° (risk of continued progression even after skeletal maturity) 1
• Curve flexibility assessment is crucial for surgical planning using:
  • Side bending radiographs
  • Push prone radiographs
  • Fulcrum bending radiographs
  • Traction radiographs 1

Treatment Effectiveness

• Bracing has shown effectiveness in preventing progression when properly applied with good compliance 2
• In one study of patients with curves >45° who refused surgery, 71% showed improvements with intensive bracing protocols 2
• Even in a case of levoscoliosis associated with Prader-Willi syndrome, multidisciplinary treatment including chiropractic care showed reduction from 15° to 4-5° over three years 4

Monitoring After Treatment

• After skeletal maturity, curves >30° should continue to be monitored for progression 5
• Adult scoliosis may progress at approximately 1° per year, particularly in thoracic curves >50° 1
• Monitoring should continue into adulthood, especially for larger curves

Pitfalls to Avoid

• Failing to identify underlying causes of scoliosis (congenital, neuromuscular, syndrome-related)
• Inadequate follow-up during rapid growth periods when progression risk is highest
• Underestimating the importance of compliance with bracing protocols
• Neglecting to monitor for curve progression even after skeletal maturity for curves >30°
• Overlooking the potential for non-surgical approaches in curves >45° when patients refuse surgery

The treatment approach should be determined by curve severity, growth potential, and risk factors for progression, with the goal of preventing curve progression and maintaining quality of life.