From the Research
An MRI is not routinely required for dextroscoliosis detected on a chest X-ray, especially if the patient reports a longstanding awareness of their abnormal upper torso anatomy. Initial management should include clinical correlation with the patient's symptoms, functional limitations, and a thorough physical examination to assess the degree of curvature. If the scoliosis is mild (typically less than 20 degrees), asymptomatic, and stable over time, conservative monitoring with periodic X-rays may be sufficient. However, an MRI should be considered if there are concerning features such as rapid progression of the curve, neurological symptoms (numbness, weakness, or abnormal reflexes), severe pain, or if the scoliosis is atypical in presentation or severe in degree. The most recent and highest quality study, 1, published in 2022, highlights the importance of diffusion tensor imaging parameters in assessing spinal cord and nerve root compression in patients with cervical spondylosis, but does not directly address the need for MRI in patients with dextroscoliosis. Key points to consider in the management of dextroscoliosis include:
- Clinical correlation with symptoms and physical examination findings
- Degree of curvature and stability over time
- Presence of neurological symptoms or severe pain
- Atypical presentation or severe degree of scoliosis
- Use of MRI to visualize the spinal cord and surrounding structures if concerning features are present, as supported by studies such as 2 and 3.