Adolescent Scoliosis Screening in Nara City Schools: A 23-Year Retrospective Cross-Sectional Study

Abstract

Study DesignRetrospective cross-sectional study.PurposeTo determine the prevalence of idiopathic scoliosis, define the distribution of the curve magnitude, evaluate the accuracy of Moiré topography as a screening tool, and investigate the cost-effectiveness of our screening system.Overview of LiteratureEarly detection of idiopathic scoliosis provides the opportunity for conservative treatment before the deformity is noticeable. We believe that scoliosis screening in schools is useful for detection; however, screening programs are controversial owing to over referral of students who do not require further testing or follow-up. In Japan, school scoliosis screening programs are mandated by law with individual policies determined by local educational committees. We selected Moiré topography as the scoliosis screening tool for schools in Nara City.MethodsWe selected Moiré topography as the scoliosis screening tool for schools in Nara City. We screened boys and girls aged 11-14 years and reviewed the school scoliosis screening results from 1990 to 2012.ResultsA total of 195,149 children aged 11-14 years were screened. The prevalence of scoliosis (defined as ≥10° curvature) was 0.057%, 0.010%, and 0.059% in fifth, sixth, and seventh grade boys and 0.337%, 0.369%, and 0.727% in fifth, sixth, and seventh grade girls, respectively. The false-positive rate of our Moiré topography was 66.7%. The minimum cost incurred for scoliosis detection in one student was 2,000 USD.ConclusionsThe overall prevalence of scoliosis was low in the students of Nara City schools. Over 23 years, the prevalence of scoliosis in girls increased compared to that in the first decade of the study.

The Clinical Effectiveness of School Screening Programme for Idiopathic Scoliosis in Malaysia

“…This finding was higher than previously reported PPV for scoliosis screening in Malaysia by Htwe et al 6 . We also found that our school screening programme was more predictive than other Asian country such as Singapore (27.5% - 47.7%) 1 , Korea (41.0% - 51.0%) 4 , China (33.8% -43.2%) 10 , and Japan (33.3%) 9 . Only the school screening programme done in Hong Kong 3 , 8 had a higher PPV than our study (76.5% - 81.0%).…”

“…The percentage of students diagnosed of scoliosis amongst those positively screened is known as the positive predictive value (PPV). Amongst the Asian countries, the PPV of school scoliosis screening ranged from 20% to 70% 1 , 3 , 4 , 6 , 9 - 11 . A previous study done in Malaysia has reported a PPV school scoliosis screening of 35.7% with a small study population of 832 students 6 .…”

Novel Hump Measurement System With a 3D Camera for Early Diagnosis of Patients With Adolescent Idiopathic Scoliosis: A Study of Accuracy and Reliability

“…Some reports recommend the scoliometer; however, there are issues, such as its weak correlation to the Cobb angle or the need for the rater to perform the forward bend or manual data measurement within a limited time [5][6]15]. MT also shows a high rate of false positives, at 35%-67% [8][9]. However, in Japan, it has continued to be widely used since the 1980s in some regions to this day as an objective method of screening [8].…”

“…Conventional Moiré topography (MT) is a method of evaluating the shape of the trunk based on the external body contour [7]. However, a limitation of MT is the high rate of false positives at 35%-67%; yet, it continues to be used in certain regions in Japan for examination [8][9]. The production of cameras for MT (FM40SC, made by Fujifilm Medical, Japan) was discontinued 10 years ago.…”

Does School Screening Affect Scoliosis Curve Magnitude at Presentation to a Pediatric Orthopedic Clinic?

“…Other studies conclude that there is not enough evidence either way to come to a conclusion regarding the benefit of school scoliosis screening, and that further evidence is needed before drawing conclusions (5, 13, 19–21). Our paper provides similar indeterminate findings regarding the benefit of school screening.…”