What is the treatment for dextroscoliosis?

Treatment of Dextroscoliosis

The treatment of dextroscoliosis should focus on preventing curve progression through appropriate imaging, conservative management including bracing and physical therapy, and surgical intervention when indicated based on curve severity and progression risk. 1

Diagnosis and Assessment

• Initial evaluation should include:

  • PA and lateral spine radiographs to diagnose and classify the scoliotic deformity
  • Assessment of curve severity using Cobb angle measurement
  • Determination of curve type (dextroscoliosis refers to right-sided curvature)
  • Evaluation of skeletal maturity (Risser stage)

• Curves are classified as:

  • Mild: 10-19 degrees
  • Moderate: 20-40 degrees
  • Severe: >40-50 degrees 1

Treatment Algorithm Based on Curve Severity

Mild Curves (10-19 degrees)

• Observation with radiographic follow-up:
  • Every 12 months for Risser stages 0-3
  • Every 18 months for Risser stages 4-5 1
• Physical therapy to improve muscle strength and posture
• No bracing typically required

Moderate Curves (20-40 degrees)

• Bracing is the primary treatment for skeletally immature patients
• Physical therapy should be included in the comprehensive management plan
• A study of patients with thoracic dextroscoliosis (20-35 degrees) showed that:
  • Kinesitherapy improved muscle strength in 80% of children
  • Curve correction was achieved in approximately 42.1% of cases 2
• Exercise programs should focus on:
  • Chest mobility
  • Muscle strength
  • Proper breathing
  • Flexibility in the spine
  • Correct posture 2

Severe Curves (>40-50 degrees)

• Surgical intervention is recommended when:
  • Curve exceeds 50 degrees in adolescents
  • There is documented progression despite conservative treatment
  • Patient experiences significant pain, cosmetic concerns, or respiratory compromise 1
• Surgery typically involves:
  • Spinal fusion with instrumentation
  • Correction of the deformity
  • Stabilization to prevent further progression 1

Special Considerations

• For congenital scoliosis: MRI evaluation is recommended to identify potential intraspinal anomalies such as tethered cord, syringohydromyelia, or diastematomyelia 3

• For patients with neurological symptoms: MRI of the thoracic spine without IV contrast is the preferred initial imaging modality to evaluate potential compressive etiologies 1

• For post-surgical patients: Multiple imaging modalities may be complementary:

  • MRI to assess for complications
  • CT without IV contrast to evaluate hardware position and fusion status
  • Radiography to assess alignment 1

Preventive Measures

• Maintain assisted ambulation to prevent progression
• Limit high-impact activities in patients with progressive curves
• Avoid activities that increase asymmetric loading on the spine
• Maintain upright and stable body position
• Avoid asymmetric weight-bearing 1

Treatment Outcomes

Successful treatment should aim to:

• Prevent further curve progression
• Correct existing deformity when possible
• Improve trunk balance and cosmesis
• Prevent potential long-term complications of untreated severe scoliosis
• Improve pain and self-image 1

Potential Complications of Surgical Intervention

• Hardware failure
• Pseudarthrosis
• Infection
• Adjacent segment degeneration
• Neurological injury 1

Physical therapy and bracing remain the cornerstone of conservative management for dextroscoliosis, with surgery reserved for severe or progressive cases that fail to respond to non-operative treatment.