Early Detection of Idiopathic Scoliosis in Adolescents

Abstract

The early detection of idiopathic scoliosis has been advocated since the 1950s and '60s, concurrent with the development in the modern era of ambulatory spinal orthoses to treat scoliosis in adolescents. This led to the development of screening programs for specific populations, as evidenced by school screening programs in the United States and public health systems in Europe and Asia. Over time, the value of population screening in terms of optimal health care and economics has been debated in the popular press, by the U.S. Preventive Services Task Force, and by professional societies. Recent studies on the effectiveness of bracing to prevent the progression of scoliosis, improved delineation of "at-risk populations," and refined orthotic management programs with emphasis on the use of compliance monitors have influenced the American Academy of Orthopaedic Surgeons (AAOS), the Scoliosis Research Society (SRS), the Pediatric Orthopaedic Society of North America (POSNA), and the American Academy of Pediatrics (AAP) to update their position on screening for scoliosis and has led to a joint position statement on the topic. AAOS, SRS, POSNA, and AAP Position Statement Screening for the Early Detection of Idiopathic Scoliosis in Adolescents This Statement was developed as an educational tool based on the opinion of the authors. It is not a product of a systematic review. Readers are encouraged to consider the information presented and reach their own conclusions. The AAOS, SRS, POSNA, and AAP believe that there has been additional useful research in the early detection and management of adolescent idiopathic scoliosis (AIS) since the review performed by the U.S. Preventive Services Task Force (USPSTF) in 2004. This information should be available for use by patients, treating health care providers, and policy makers in assessing the relative risks and benefits of the early identification and management of AIS. The AAOS, SRS, POSNA, and AAP believe that there are documented benefits of earlier detection and non-operative management of AIS, earlier identification of severe deformities that are surgically treated, and incorporation of screening of children for AIS by knowledgeable health care providers as a part of their care.

Low Body Mass Index for Early Screening of Adolescent Idiopathic Scoliosis: A Comparison Based on Standardized Body Mass Index Classifications

“…However, in a previous study, the BMIs of AIS participants aged 15e17 years were significantly lower than those of the healthy group [17]. Boys reach puberty approximately 2 years after girls at age 13e14 years [33]; therefore, the different outcome observed in this study is thought to be because our population included seventh grade students corresponding to 13-year-old students, i.e., before puberty. In this study, the higher BMI group was shown to have low occurrence of AIS in both sexes.…”

Screening for Adolescent Idiopathic Scoliosis

“…The Scoliosis Research Society (SRS) recommends an ATR of 5°to 7°as a threshold for referral for radiography. 1 Cobb angle: Measure, in degrees, of lateral spinal curvature. 2 Requires radiographs for measurement.…”

Ahead of the Curve: Pediatric Scoliosis

“…The American Academy of Pediatrics, as well as several orthopedic societies, endorse the position of the Scoliosis Research Society that advocates screening examinations for scoliosis to occur at 10 to 12 years of age for females and 13 to 14 years of age for males. 2,4 Similarly Bright Futures recommends spine examination at every well-child encounter to assess for deformity and scoliosis. 24 While obtaining a history, particular attention should be paid to the patient's past medical and surgical history.…”

“…Modern imaging techniques, as well as careful clinical examination, have revealed that it is also a 3-dimensional deformity including rotation and often results in lordosis at the apex of the curvature. 2 Scoliosis may be postural, also called nonstructural or functional scoliosis; this type is easily manipulated with postural supports or positional cues. However, most scoliosis is structural and is the result of wedgeshaped changes to the affected discs and vertebrae 3 and includes specific types of scoliosis like idiopathic and neuromuscular scoliosis.…”