INTRODUCTION

Scoliosis is a medical condition where there is a curvature in the spinal column of the

body and the curve may either be towards the left or towards the right. About 3 out of every 100

people have some type of curve to their spine. Scoliosis generally occurs in children aged 10 to

15 years, when they experience their growth spurt. However, it can occur at other ages if it’s

caused by something else like a muscle disease. Preteen and teenage girls have a higher risk of

developing scoliosis than boys of the same age. Girls are also more likely to experience more

progressive forms of scoliosis. Dextroscoliosis is the term used to describe the scoliosis of the

spine with a spinal curvature to the right side of the body. It is the more common type of

scoliosis. Both, children as well as the adults can be affected by this condition of scoliosis where

the spinal column is curved towards the right.

Definition of the Disease

As mentioned earlier, when the curvature of the spine is towards the right side of the
body; the scoliosis is known as Dextroscoliosis. Unlike Levoscoliosis, the curvature of the spine
towards the left side of the body, Dextroscoliosis is less dangerous as the condition do not affect
the heart. However, this medical condition in a person affects various internal organs like kidney,
lungs etc which are affected because of the deformation of the ribcage towards the right side of
the body. The right-sided curvature of the spine can cause the spinal column to appear in the
shape of a “C” or an “S” instead of a normal straight line. It typically affects the middle to upper
areas of the back known as the thoracic spine.
Two of the most common form includes the Thoracic Dextroscoliosis and the Lumbar
Dextroscoliosis. Thoracic Dextroscoliosis is a condition of the Dextroscoliosis where the
thoracic region of the spine is deformed or curved towards the right side of the body. The case of
Lumbar Dextroscoliosis, on the other hand, the Lumbar region of the spine is deformed or
curved towards the right side. There is also one more form known as Mild Dextroscoliosis which
explains about a condition in Dextroscoliosis where there is only a slight curvature of the spine
(i.e. about 10 degree) towards the right. Though it may be mild; one must be very much aware
that all the large or severe curvatures of the spine begin from the mild curves. So, there must be a
proper diagnosis and treatment even in the Mild dextroscoliosis to prevent it from growing
severe.

Doctors don't know what causes the most common type of scoliosis — although it
appears to involve hereditary factors, because the disorder tends to run in families. The causes of
Dextroscoliosis are some patients may have the condition because of Idiopathic Scoliosis. Vast
majority of scoliosis cases diagnosed (over 80%) are termed idiopathic. Idiopathic Scoliosis has
no known cause, so there are no preventative measures that can be taken at this time. Some
people appear to be genetically predisposed to developing this type of scoliosis. Trauma, injuries
or infections to the spinal column may also cause Dextroscoliosis. Degenerative spinal diseases
also lead to the condition where the spine can have a curvature towards the right side of the
body. Some neuromuscular diseases such as cerebral palsy or muscular dystrophy can also be
causes for Dextroscoliosis.

Risk Factors

 Age. Signs and symptoms typically begin during the growth spurt that occurs just prior to
puberty.

 Sex. Although both boys and girls develop mild scoliosis at about the same rate, girls
have a much higher risk of the curve worsening and requiring treatment.

 Family history. Scoliosis can run in families, but most children with scoliosis don't have
a family history of the disease. It is possible for certain genes to predispose an individual to
develop scoliosis, but there is no way to tell just by looking at the genes if a person will
develop scoliosis or not.  Rather, it appears to be a combination of genetic and
environmental factors that influences the development of scoliosis.
  Osteopenia. Low bone density.

 Ligament laxity. Joint hypermobility.

 Environmental aspects. Ectomorphic body types (tall and slender), loss of the normal
thoracic kyphosis (flatback syndrome), and abnormal loading of the bones (Heuter-
Volkmann’s Law).

 Sensorimotor re-integration disorder. Improper communication between the brain and

the muscles responsible for posture, balance, and coordination.

Signs and Symptoms

 Uneven shoulders, with a difference in shoulder height

 Shoulder blade prominence, with one shoulder blade protruding out farther than the other

 Rib prominence, with the ribs on one side of the body protruding out more than the other
side

 Uneven waistline, with a difference in height between the two sides

 Uneven hips, with a difference in height between the two sides

 A noticeable curve to the spine

 Head tilt, with the head leaning more to one side

 Body tilt, a leaning of the upper body to one side

 Arms are held rigidly by the side during gait

 Problems with their proprioception, which can affect balance and coordination. 

For people with scoliosis who have severe curves, their curved spine may press on other organs
and areas of their body. This can cause severe symptoms such as:

 Difficulty breathing and shortness of breath if the lung is compressed

 Chest pain

 Back pain

 Leg pain

 Neck pain
 Feet pain

 Headaches

 Difficulty sleeping

 Muscle tension

 Changes and difficulties with urination or defecation

 Problems with digestion and proper bowel function

ANATOMY AND PHYSIOLOGY

The skeletal system supports and protects the body while giving it shape and form. This
system is composed of connective tissues including bone, cartilage, tendons, and ligaments.
Nutrients are provided to this system through blood vessels that are contained within canals in
bone. The skeletal system stores minerals and fats and produces blood cells. It also provides
mobility. Tendons, bones, joints, ligaments, and muscles work in concert to produce various
movements. Bones are a major component of the skeletal system. Bones that comprise the
human skeleton are divided into two groups. They are the axial skeletal bones and appendicular
skeletal bones. An adult human skeleton contains 206 bones, 80 of which are from the axial
skeleton and 126 from the appendicular skeleton.

Axial Skeleton

The axial skeleton includes bones that run along the medial sagittal plane of the body.
Imagine a vertical plane that runs through your body from front to back and divides the body into
equal right and left regions. This is the medial sagittal plane. The axial skeleton forms a central
axis that includes bones of the skull, hyoid, vertebral column, and thoracic cage. The axial
skeleton protects numerous vital organs and soft tissues of the body. The skull provides
protection for the brain, the vertebral column protects the spinal cord, and the thoracic cage
protects the heart and lungs.

Axial Skeleton Components

 Skull: includes bones of the cranium, face, and ears (auditory ossicles).
 Hyoid: U-shaped bone or complex of bones located in the neck between the chin and
larynx.
 Vertebral column: includes spinal vertebrae.
 Thoracic cage: includes ribs and sternum (breastbone).

Appendicular Skeleton

The appendicular skeleton is composed of body limbs and structures that attach limbs to
the axial skeleton. Bones of the upper and lower limbs, pectoral girdles, and the pelvic girdle are
components of this skeleton. Although the primary function of the appendicular skeleton is for
bodily movement, it also provides protection for organs of the digestive system, excretory
system, and reproductive system.

Appendicular Skeleton Components

 Pectoral girdle: includes shoulder bones (clavicle and scapula).

 Upper limbs: includes bones of the arms and hands.
 Pelvic girdle: includes hip bones.
 Lower limbs: includes bones of the legs and feet.

Human Spine Anatomy and Physiology

The human spine extends from the lower back to the brain and is part of the central
nervous system. It consists of a spinal cord, the outer layer of which is made up of myelin-
sheathed nerve fibers. It has specialized tracts that send impulses such as pain, pressure and other
stimuli. The cord is then covered and protected by vertebral column, which is also called spinal
column. It has 33 bones (7in cervical region, 12 in thoracic region, 5 in the sacral region, 5 in the
lumbar region, and another 4 in the coccygeal region).

I. Spinal Curves

The spine is naturally S-shaped, which is why it’s called spinal curve. Two regions (the
cervical and lumbar) both have slight concave curve. The other two regions (the thoracic and
sacral) have convex curve. The S-shaped curve helps the body maintain balance, absorb shock
and allow a range of motion, by working like a coiled spring.

II. Vertebrae

This is the bones that interlock to protect the spinal

cord and form the entire spinal column. It has 33
individual bones, all in all, divided in five regions:
cervical, thoracic, lumbar, sacrum, and coccyx. Each
region has unique feature and serve a distinct function.
Of the 33 bones, only 24 are movable.

 Cervical (neck)
The cervical spine is otherwise known as the
“neck.” Its main function is to support and
balance the head. It has two specialized
vertebrae connected to the skull, which makes
the neck the most moveable part of the spine. It
 also has a peg-shaped axis which allows the neck to move sideways. Due to the wide
range of movement, one is prone to neck pain.

 Thoracic (mid back)

The thoracic is called the mid back. It holds rib cage that protects the lungs and heart.
There are 12 thoracic vertebrae (T1 to T12). However, unlike the neck, its range of
motion is limited.

 Lumbar (low back)

The lumbar is known to many as “low back.” Its main purpose is to support and hold the
weight of the body.  It has five vertebrae (L1 to L5). These vertebrae are larger and
sturdier in order for them to absorb the shock when carrying and lifting heavy objects.

 Sacrum
This region connects the spine to the iliac or hip bones. There are five vertebrae in this
region, which are all fused together. This and the hip bones form the pelvic girdle.

 Coccyx region
This is also called the tailbone. It has four fused bones. The coccyx attaches the ligaments
and muscles to the pelvic floor.

III. Intervertebral discs

The intervertebral discs serve as a cushion to each of the vertebra. It separates each bone
and keeps them from rubbing together. It has an outer ring that consists of criss-crossing fibrous
brands. These pull the vertebral body from the elasticity of the nucleus. The inner part of the disc
is the nucleus, which is a gel-filled center that is mostly composed of fluid. It allows the
vertebral body to roll over the gel.

IV. Vertebral Arch & Spinal Canal

These are bony projections found at the back of each vertebra. Each arch is composed of
two laminae and two supporting pedicles. On other hand, the spinal canal is a hollow space that
contains the cord, ligaments, fat and blood vessels.

V. Facet joints

These are the joints in the spine that allow back motion. There are four facet joints in
every vertebra. The two joints (superior facets) connect to the upper part of the vertebra, while
the other two joints (interior facets) connect to the lower part.
VI. Muscles

There are two muscle groups in the spine: the extensors and flexors. The extensors, which
are attached to the back part of the spine, allow people to lift objects and stand up. The flexors,
which are found in the front, enable people to bend forward and flex. It also controls the arch in
the lower back. These muscles help stabilize the spine.

VII. Ligaments

These are strong fibrous brands. They protect the discs, stabilize the spine and hold
together the vertebrae. There are three ligaments found in the spine: the ligamentum flavum, the
posterior longitudinal ligament (PLL), and the anterior longitudinal ligament (ALL). The
ligamentum flavum attaches the lamina of every vertebra. The ALL and PLL prevent excessive
movement in the vertebral bones; they run along the vertebral bodies, from the bottom to top of
the spinal column.

VIII. Spinal cord

The spinal cord, which is generally 18 inches long, is found within the spinal canal, and
runs from the brainstem down to the first lumbar vertebra. It ends there and separate into cauda
equine, where it continues down to the tailbone. The main function of the spinal cord is relaying
messages to and fro the brain and body. It is responsible for the sending of motor messages
throughout the body from the brain. That’s why we feel and react. There are instances where one
immediately reacts without it sending sensory messages to the brain. This is due to the spinal
reflexes or special pathways. The nerve cells in the spinal cord are upper motor neurons, while
the nerve cells down your back are lower motor neurons.

TEST AND DIAGNOSTICS

Dextroscoliosis, as with all types of scoliosis, is diagnosed by a doctor during a physical

examination. The exam generally includes:

 Looking at your spine from the back

 Checking for shoulder, waist, and hip height to see if both sides are even or uneven

 Examining both sides of your rib cage to see if one side sticks out more than the other

 Having you perform the Adam’s forward bending test, which involves bending forward
with your feet together, knees straight, and arms dangling loose at the sides of your body

 Taking X-rays of your spine so your doctor can see where the curve is located and
determine how much of a curve exists
 CT scan or an MRI scan of your back.

TREATMENT

Treatment options include nonsurgical and surgical approaches. Your specific treatment plan will
depend on:

 how severe your scoliosis is

 the location of the curve

 the risk of progression

 your age

Nonsurgical

If the curve is less than 25 degrees and not rapidly worsening, your doctor will take X-rays and
possibly other imaging tests every 6 to 12 months to monitor your condition.

If your spinal curves are between 25 to 45 degrees, your doctor may recommend bracing or
casting to help support your spine. This won’t correct a curve, but it can help to prevent curves
from worsening.

Surgical

Your doctor may recommend surgery if your curves are:

 severe

 worsening over time

 causing severe and obvious deformities

 resulting in additional complications, such as neurological or breathing problems

There are different surgical approaches, including:

Spinal fusion: In this procedure, the surgeon repositions the spinal bones that form the curve and
fuses them together into one bone using a bone graft. The bone graft is placed between the
vertebrae that form the curve.

Metal rod(s) or growing rod: This involves anchoring one or two metal rods to the spine above
and below the area with the curve with wires, hooks, or screws. With the growing rod approach,
the surgeon can later extend the rod with a minor surgical procedure.

Hemivertebra removal: This involves removing one portion of one vertebra to help lessen the
severity of the curve. A metal implant may then be added.

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https://www.healthline.com/health/dextroscoliosis#symptoms
https://www.epainassist.com/bones/dextroscoliosis
https://www.mayoclinic.org/diseases-conditions/scoliosis/symptoms-causes/syc-20350716
https://www.thoughtco.com/skeletal-system-373584
https://gotpainarizona.com/human-spine-anatomy-physiological-functions/