An older woman pushing herself up from a sofa at home, holding her lower back, with a hot water bottle beside her.

Most people meet lumbar levoscoliosis on a report they were not expecting, after an X-ray for back pain. It sounds like a diagnosis of its own. It is not: it is scoliosis, described by which way it bends.

What the word actually says

Lumbar — the curve is in the lower back, rather than the upper back or neck
Levo — it bends towards the left. A curve bending right is called dextroscoliosis
Scoliosis — a sideways curve of 10 degrees or more on an X-ray, usually with some rotation of the vertebrae

So the report has told you the location and the direction. It has not told you whether the curve matters. A 12-degree curve and a 50-degree curve can carry the same word.

How big is it? The Cobb angle

The size of a lumbar levoscoliosis curve is measured on a standing X-ray as the Cobb angle, taken between the most tilted vertebra at each end of the curve. That number, and whether it changes over time, drives everything else.

Cobb angle	What it usually means
Under 10 degrees	Not scoliosis. A small asymmetry, very common
10 to 20 degrees	A mild curve. Most never cause trouble; watched rather than treated
20 to 40 degrees	Moderate. In a growing child, the range where a brace is considered
Over 40 degrees	Large. More likely to progress, and the range where surgery is discussed — though what the curve is doing matters more than the number alone

Who gets a left-sided lumbar curve

Adults, from wear. The commonest reason by far, usually over 50. The discs and small joints of the spine wear unevenly, a segment tilts, and a curve appears where there was none before.
Teenagers, from adolescent idiopathic scoliosis. The classic pattern is a right-sided curve in the upper back, so a left-sided lower back curve is less typical — which is a reason to look at it carefully rather than a reason to worry.
Less often, a curve present from birth or one caused by a condition affecting the nerves and muscles.

What it feels like

Often nothing at all. Small curves are usually found by accident and cause no symptoms. When a curve does cause trouble, it tends to do so in two ways:

Aching in the lower back, worse after standing or walking for a while, as the muscles work to hold the trunk upright
Leg symptoms, when a collapsing curve narrows the channels the nerves pass through. That can cause sciatica, or the leg pain on walking of spinal stenosis

Severe pain, or pain that wakes you at night, is not typical of a curve this size and is a reason to look for another cause. See back pain.

Lumbar levoscoliosis treatment: what helps

Monitoring. For a mild curve causing no trouble, repeat X-rays at intervals to see whether it is changing. Adults with a curve that causes no symptoms need no treatment at all.
Exercise. General activity for the back, and scoliosis-specific exercise programmes, which aim to improve posture and stability rather than straighten the spine.
A brace, while a child is still growing. For a curve of roughly 20 to 40 degrees. A brace does not straighten the spine; it aims to stop the curve reaching the size where surgery is advised, and it stops being useful once growth finishes.
Treatment for the pain, including medication, and an injection where a nerve is irritated. An injection eases symptoms for a time; it does not change the curve.

When surgery is considered

Surgery is for nerve compression that has not settled, for a trunk that is tipping forward or sideways and cannot be held upright, or for a curve that is clearly getting worse. What it involves:

Correction and fusion — screws and rods straighten the curve and hold it while the vertebrae fuse. Robotic assistance can improve the accuracy of screw placement
Decompression — freeing nerves where the curve has narrowed the spaces they pass through, usually alongside fusion, since removing bone from a curved spine without stabilising it can let the curve worsen

See scoliosis for the fuller picture, and decompression surgery for what freeing a nerve involves.

The symptoms that cannot wait

A curve itself is rarely urgent. Pressure on the nerves can be:

Numbness around the groin, buttocks or inner thighs (saddle numbness)
Any new difficulty passing urine, or loss of bladder or bowel control
Weakness in both legs, or weakness that is getting worse

Call us on +65 8849 0677 — we will see you the same day. If we are closed, go to an emergency department.

Who you will see

Dr Lim Heng Hing, a Senior Consultant Orthopaedic and Spine Surgeon, treats scoliosis and complex spinal deformity, which is a particular interest of his, using endoscopic and robotic techniques. Dr Mathew Tung, a neurosurgeon, treats the brain, spine and nerve side of the same problems. You do not have to choose between them before booking.

Scoliosis · Back pain · Lower back pain · Spinal stenosis · Kyphosis · All spine and neck conditions

Lumbar levoscoliosis: what it means and what to do