Estimating the Effectiveness of Screening for Scoliosis: A Case-Control Study

Abstract

OBJECTIVE. The aim of this study was to test the hypothesis that screening for scoliosis is effective in reducing the need for surgical treatment. METHODS. The study was a case-control study. A total of 125 consecutive patients who were treated surgically for idiopathic scoliosis between January 2001 and October 2004 and who were born on or after January 1, 1984, were invited; 108 agreed to participate. A total of 216 control subjects were selected randomly and anonymously, matched with respect to age and gender. For 279 adolescents, exact screening exposure and outcomes could be analyzed. Case subjects were recruited from 4 university and 6 nonuniversity Dutch hospitals; control subjects were recruited from all 37 municipal health services in the Netherlands. RESULTS. Screen-detected patients received diagnoses at a significantly younger age than did otherwise-detected patients (10.8 ± 2.6 vs 13.4 ± 1.7 years). In total, 32.8% of the surgically treated patients had been screened between 11 and 14 years of age, compared with 43.4% of the control subjects. The odds ratio for being exposed to screening was 0.64. In total, 28% of the patients were diagnosed as having scoliosis before 11 years of age. CONCLUSIONS. Our results showed no evidence that screening for scoliosis reduced the need for surgery. Abolishing screening seems justified, especially because the effectiveness of early treatment with bracing is still strongly debated. A randomized, controlled trial on the effectiveness of treating patients with idiopathic scoliosis with bracing is urgently needed.

Ultrasound Volume Projection Imaging for Assessment of Scoliosis

“…However, the sensitivity and specificity of scoliosis screening depends on the experiences of the examiner. Therefore, the effectiveness of scoliosis screening is still under dispute [38][39][40][41][42]. Moreover, the screening could increase exposure to radiographs because the radiography is required to officially diagnose scoliosis for positive findings of a rib hump [42].…”

The evaluation of dorsal asymmetry in children and adolescents: ten years’ follow-up

“…Spo strze że nia po wy ższe po twier dza ją ba da nia Bunge, któ ry po przez re tro spek tyw ną ana li zę wy wia du od osób ope ro wa nych z po wo du sko lio zy wy ka zał, że ba da nie prze sie wo we w wie ku 11-14 lat wy ko na no tyl ko u 32,8% osób ope ro wa nych z po wo du bocz ne go skrzy wie nia krę go słu pa. Na to miast u 43,4% ope ro wanych nie wy ko ny wa no wcze śniej ba da nia prze sie wowe go [23].…”

School Scoliosis Screening - World Trends and the Problems Encountered in Japan

“…Some studies concluded that SSS is effective, whereas others questioned the effectiveness or even considered such screening to be unethical [23] . Arguments against screening are as follows: (1) low predictive value leading to excessive number of children referred to specialists; (2) possibly increased amount of x-ray imaging in children; (3) lack of certainty about which instance of small scoliosis (Cobb angle < 20°) will progress and require treatment; (4) cost issue and (5) stress induced by examination [6] .…”

“…Bunge et al [23] performed a case-control study estimating the effectiveness of SSS in the Netherlands. Their results showed no evidence that SSS using the FBT reduced the need for surgery.…”