Lumbar lateral shift Vs. Scoliosis

Sciatic scoliosis, also known as sciatic scoliotic list (SSL) [Matsui H, et al. 1998; Krishnan KM, and Newey ML. 2001], trunk list [Gillan MG, et al. 1998], or trunk shift [Wu W, et al. 2019], is acknowledged as a nonstructural scoliosis reactive to nerve root irritation. It is observed in 13.2–17.7% of adults with lumbar disc herniation (LDH) [Kim R, et al. 2015; Zhang Y, et al. 2019; Gillan MG, et al. 1998].

Ipsilateral shift – leaning toward the painful side.

•Contralateral shift – leaning away from the painful side (more common) [McKenzie RA. 1972; Tenhula JA, et al. 1990; Matsui H, et al. 1998].

•Alternating scoliosis – shifting between both sides, also referred to as alternating lumbar lateral shift [Capener N. 1933; Peterson S, and Laslett M. 2020].

This shift occurs as a reaction to spinal nerve compression or irritation, which may be due to muscle spasms or postural compensation [Weitz EM. 1976; Falconer MA, et al. 1948; Grieve GP. 1983; White AA, and Panjabi MM. 1990].

Two primary theories explain the direction of the shift:

1. Finneson’s Theory [Akhaddar A. 2023; Matsui H, et al. 1998]:

• Laterally herniated discs → shift away from pain.

• Medially herniated discs → shift toward pain.

2. Disc Mechanics Theory [Porter RW, and Miller CG. 1986; McKenzie RA. 1972]:

• Disc herniation pushes the trunk away.

• Vertebral collapse shifts the trunk toward pain.

Sciatic scoliosis is strongly associated with intervertebral disc pathology [Suk KS, et al. 2001]. Unlike idiopathic scoliosis, sciatic scoliosis is temporary and resolves when the underlying cause is treated.

McKenzie’s (1981) criteria for diagnosing a lateral shift include [Tenhula JA, et al. 1990]:

• A noticeable upper body shift.

• The shift occurs alongside back pain.

• The patient cannot voluntarily correct their posture.

• Restricted or painful side-bending.

• Symptoms change when attempting to correct the shift.

A side-bending test is used to confirm both the presence and direction of the shift.

Physiotherapists must be cautious when correcting a lateral shift. Treatment should be stopped immediately if [Laslett M. 2009]:

• Pain worsens or spreads.

• Nerve symptoms appear (e.g., numbness, weakness, bowel/bladder dysfunction).

• The trunk cannot realign despite repeated attempts.

• The patient experiences dizziness or nausea, requiring gentler methods.

If correction is not possible, alternative treatments should be explored instead of forceful realignment.

A key distinction between sciatic scoliosis (lumbar lateral shift) and idiopathic scoliosis is vertebral rotation.

• Idiopathic scoliosis is a structural condition with a persistent spinal curve and visible vertebral rotation on X-rays. It develops gradually and may progress over time [K.-L. Hsu et al. 2012].

• Sciatic scoliosis (lumbar lateral shift) is a temporary postural adaptation due to pain or nerve irritation, such as a herniated disc. It does not involve vertebral rotation and usually resolves when the underlying nerve issue is addressed [Pinto FC, et al. 2002].

When painful scoliosis is present in adolescents or young adults, clinicians should investigate potential underlying causes, such as disc herniation, spondylolisthesis, or tumors [Afshani E, Kuhn JP. 1991; Pneumaticos SG, Esses SI. 2003; Burke NG, et al. 2011].

Understanding sciatic scoliosis vs. idiopathic scoliosis is crucial for accurate diagnosis and treatment:

• Sciatic scoliosis is a temporary postural shift due to nerve irritation.

• Idiopathic scoliosis is a structural spinal deformity with vertebral rotation.

• Physiotherapy should focus on treating the root cause, not forcing alignment.

By identifying a lumbar lateral shift early, healthcare professionals can avoid unnecessary interventions and focus on effective pain relief.

•Akhaddar, A. (2023). Atlas of Sciatica: Etiologies, Diagnosis, and Management. Springer.

•Burke, N. G., Walsh, J., McEvoy, S., Heffernan, E., & Dudeney, S. (2011). Scoliosis secondary to a rib haemangioma. Joint Bone Spine, 78, 527.

•Capener, N. (1933). Alternating Sciatic Scoliosis. Proceedings of the Royal Society of Medicine, 26(4), 425-429. PMID: 19989147.

• Falconer, M. A., McGeorge, M., & Begg, A. C. (1948). Surgery of lumbar intervertebral disk protrusion; a study of principles and results based upon 100 consecutive cases submitted to operation. British Journal of Surgery, 35(139), 225-249. doi: 10.1002/bjs.18003513902.

•Gillan, M. G., Ross, J. C., McLean, I. P., & Porter, R. W. (1998). The natural history of trunk list, its associated disability and the influence of McKenzie management. European Spine Journal, 7(6), 480-483. doi: 10.1007/s005860050111.

•Hsu, K., Tai, T., Chien, J., & Lin, C. J. (2012). Sciatic scoliosis: An easily misdiagnosed disease in adolescents and young adults. Tzu Chi Medical Journal, 24(4), 196-200.

•Kim, R., Kim, R. H., Kim, C. H., Choi, Y., Hong, H. S., Park, S. B., Yang, S. H., Kim, S. M., & Chung, C. K. (2015). The incidence and risk factors for lumbar or sciatic scoliosis in lumbar disc herniation and the outcomes after percutaneous endoscopic discectomy. Pain Physician, 18(6), 555-564. PMID: 26606007.

•Krishnan, K. M., & Newey, M. L. (2001). Lumbar scoliosis is associated with a disc herniation in an adult. Rheumatology (Oxford), 40(12), 1427-1428. doi: 10.1093/rheumatology/40.12.1427.

•Laslett, M. (2009). Manual correction of an acute lumbar lateral shift: Maintenance of correction and rehabilitation: A case report with video. Journal of Manual & Manipulative Therapy, 17(2), 78-85. doi: 10.1179/106698109790824749.

•Matsui, H., Ohmori, K., Kanamori, M., Ishihara, H., & Tsuji, H. (1998). Significance of sciatic scoliotic list in operated patients with lumbar disc herniation. Spine (Phila Pa 1976), 23(3), 338-342. doi: 10.1097/00007632-199802010-00010.

•McKenzie, R. A. (1972). Manual correction of sciatic scoliosis. New Zealand Medical Journal.

Abdelrahmen Taha

PT, MSc

Esraa elghanem

Specialized in spinal deformities, Certified by ISST Schroth