Levoconvex scoliosis means the curve bulges toward the left side of the body. Dextroconvex means it bulges to the right. The word describes direction, not severity. Its importance depends on where the curve is and how old the patient is. A left-bending curve in the thoracic spine, the middle back, is the pattern that most often raises the question of an MRI. Families in Charlotte see this term on reports and want to know whether it changes anything. Sometimes it does.
Why a Left Thoracic Curve Gets Attention
In a prospective study, 68 patients with presumed idiopathic scoliosis and a left thoracic curve had MRI of the neural axis, the brain stem and spinal cord (Wu, Spine 2010). Abnormalities were found in 37, or 54%, including Chiari I malformation and syringomyelia, a fluid-filled cavity in the cord. Male sex and larger curves were associated with abnormal findings. The authors recommended strong consideration of MRI when a left thoracic curve is present, especially in boys or larger curves.
In 504 infants and children under about 10 with presumed idiopathic scoliosis, 18.7% had a neural axis abnormality on MRI, and male sex, a left thoracic curve, and a right lumbar curve were each significantly associated with those findings (Zhang, BMC Musculoskelet Disord 2016).
The Study That Disagrees
A Danish group performed full-spine MRI on 381 consecutive adolescents with idiopathic scoliosis regardless of curve size (Fruergaard, Neurospine 2019). Abnormalities were found in 8.9%, mostly a syrinx. In that population, a left thoracic curve, curve convexity, curve size, and sex did not predict an abnormal MRI. Four patients were referred to neurosurgery, and none needed surgery. The authors did not support routine MRI in all adolescents with idiopathic scoliosis.
How to Reconcile Them
The studies enrolled different populations. The Chinese studies included younger children and a selected group of left thoracic curves. The Danish study was an unselected adolescent population. Age, sex, curve pattern, and neurologic findings all shape the decision. A left thoracic curve in a young child or a boy, or any curve with abnormal reflexes, pain at night, or rapid progression, makes MRI more reasonable. A left curve in the lumbar spine of an otherwise typical adolescent carries less concern in these data.
How I Handle It
I record the curve direction, region, and size, perform a neurologic screen, and discuss MRI with the family and the treating physician when the pattern or the exam raises the question. The direction of a curve is information. It is not a diagnosis.
For an example of how post-collision imaging findings and outcomes are documented in the peer-reviewed literature, read the published case report on refractory lumbar pain following a motor vehicle accident in a geriatric patient by Dr. Justin Dick, DC.
Frequently Asked Questions
What does levoconvex scoliosis mean?
It means the scoliosis curve bulges toward the left side of the body. Dextroconvex means it bulges to the right.
Is levoconvex scoliosis more serious?
Not by itself. A left thoracic curve has been associated with spinal cord findings on MRI in some studies, especially in boys and young children (Wu, Spine 2010).
Does a left thoracic curve need an MRI?
Some studies recommend considering MRI, especially in boys, young children, or larger curves. A Danish study of 381 adolescents found curve direction did not predict MRI findings (Fruergaard, Neurospine 2019).
What is a neural axis abnormality?
It is a structural finding in the brain stem or spinal cord, such as Chiari malformation or syringomyelia, that can accompany scoliosis.
How does Dr. Justin Dick, DC evaluate a levoconvex curve?
Dr. Justin Dick, DC in Charlotte, NC records direction, region, and size, performs a neurologic screen, and discusses MRI with the family and physician when indicated.
Where can I get a scoliosis evaluation in Charlotte, NC?
Dr. Justin Dick, DC, CLEAR Institute Senior Fellow and CNMT, ARRT(N)(CT), sees patients at Clear Life Scoliosis and Chiropractic Center, 8814 Rachel Freeman Wy, Ste 103, Charlotte, NC 28278, phone 980-368-0766.
Sources and Evidence Tiers
- Wu L, Qiu Y, Wang B, Zhu ZZ, Ma WW. The left thoracic curve pattern: a strong predictor for neural axis abnormalities in patients with idiopathic scoliosis. Spine. 2010;35(2):182-185. PMID 20081514. LinkEvidence tier: Prospective MRI study (68 patients)
- Zhang W, Sha S, Xu L, Liu Z, Qiu Y, Zhu Z. The prevalence of intraspinal anomalies in infantile and juvenile patients with presumed idiopathic scoliosis: a MRI-based analysis of 504 patients. BMC Musculoskelet Disord. 2016;17:189. PMID 27121616. LinkEvidence tier: Retrospective cohort (504 patients)
- Fruergaard S, Ohrt-Nissen S, Dahl B, Kaltoft N, Gehrchen M. Neural axis abnormalities in patients with adolescent idiopathic scoliosis: is routine magnetic resonance imaging indicated irrespective of curve severity? Neurospine. 2019;16(2):339-346. PMID 30653908. LinkEvidence tier: Prospective cohort (381 patients)
About the author. Dr. Justin Dick, DC, is the owner and treating clinician at Clear Life Scoliosis and Chiropractic Center in Charlotte, NC. He holds dual imaging credentials as a Certified Nuclear Medicine Technologist (CNMT) and as an ARRT-registered technologist in nuclear medicine and CT, ARRT(N)(CT). He is a Senior Fellow of the CLEAR Institute, holds the ISICO World Masters credential, is a SOSORT provisional member, and is a certified DOT medical examiner on the FMCSA National Registry. He has multiple peer-reviewed publications indexed in PubMed and serves as a field doctor for Life, Sherman, and Palmer chiropractic colleges. ORCID: 0009-0001-2794-2159.
Service Area
Clear Life Scoliosis and Chiropractic Center sees personal injury and spinal imaging patients from Charlotte NC, Huntersville NC, Ballantyne NC, Matthews NC, Concord NC, Mooresville NC, Rock Hill SC, and Fort Mill SC.
Related Pages
- Personal injury and car accident spinal care in Charlotte
- Research by Dr. Justin Dick, DC
- Case report: refractory lumbar pain after a motor vehicle accident
- Research and evidence at Clear Life
- Questions and answers
- Our team
- Press
- Book your evaluation
- Contact Clear Life
Clear Life Scoliosis and Chiropractic Center
8814 Rachel Freeman Wy, Ste 103
Charlotte, NC 28278
Phone: 980-368-0766
Email: office@clearlifescoliosis.com
Book online
