Scoliosis Screening Explained

By Ryan Sauber, MD – AHN Pediatric Orthopedic Institute

A little information can be a dangerous thing. An observant school

nurse or a thorough Pediatrician during an annual wellness visit says there is something wrong with a child’s spine and it needs to be checked out. Few referrals bring about more confusion, concern, and sometimes outright terror than a referral to a spine surgeon for scoliosis. Visions of stiff braces, years of doctor appointments, and long surgical scars immediately come to mind. Parent and child alike flock to the internet for their research. Facebook groups, YouTube channels, and various other social media outlets provide hours upon hours of information, but how much of it is reliable or even relevant? Luckily, a national campaign seeks to change all of this.

Scoliosis Awareness Month is celebrated by patients and their families each June to help improve the world’s understanding about the disease, to recognize its symptoms, encourage early detection and effective treatment. Despite affecting up to 5% of the adolescent population and perhaps more than 25% of the adult population, scoliosis remains a bit of a mystery to most Americans. Multiple medical societies including the Scoliosis Research Society (SRS) are pushing to bring the disease to light and encourage people to seek treatment. Part of this educational campaign is to raise awareness regarding the benefits of early detection and treatment to prevent the need for surgical intervention.

Surprisingly, the idea of screening for scoliosis is actually controversial. In 2004 the United States Preventative Services Task Force (USPSTF), recommended against routine screening for scoliosis in adolescents without symptoms of the disease. Their decision was based on lack of evidence that screening led to early detection of the disease, and some evidence to suggest that screening could lead to harm based on overtreatment. Multiple professional societies came out against this ruling by the USPSTF. The SRS, American Academy of Orthopaedic Surgeons (AAOS), Pediatric Orthopaedic Society of North America (POSNA) and the American Academy of Pediatrics (AAP) came out against this recommendation. While there are some potential downsides of over-diagnosis, the benefits of early detection and treatment can be substantial. These societies put together a joint statement recommending the screening of adolescent females twice, at 10 and 12 years of age, during an annual wellness visit, and in males once at 13 or 14. They specified that the screening should be done by a well-qualified individual and should consist of forward bend testing, with the use of a special instrument called a scoliometer, and a thorough history and physical exam.

Widespread screening certainly can lead to over-treatment including excessive specialist referrals and unnecessary radiation. Fortunately, not all patients who are referred to a pediatric spine specialist need surgery or even x-rays. If x-rays are

required, new technology has been developed, like the EOS system, which allows for evaluation of the entire spine with a fraction of the radiation. Using this technology, 3D models of the entire spine can also be created to help with patient education, treatment decision making, and surgical planning. This has significantly reduced the amount of radiation patients with scoliosis are exposed to during their treatment.

Once the diagnosis of scoliosis is confirmed, early treatment can be instituted to decrease the likelihood that surgical intervention will be necessary. A specialized type of exercise with the help of a physical therapist may be recommended for a child with scoliosis. In addition, for spinal curvatures which represent a higher risk, a custom made, 3D modeled brace may be prescribed. The newest generation of braces for scoliosis provide strong curve correction while allowing for greater comfort to the wearer. Newer braces can also be worn below loose-fitting clothes making the child feel at ease while at home or in social situations.

It has never been safer to be screened or treated for scoliosis. While over-treatment is always a concern, pediatric spine care providers are hard at work coming up with new ways to decrease the risk of scoliosis care. The spinal deformity team at the Pediatric Orthopaedic Institute in Wexford provides multidisciplinary care in a single location focused on aggressive nonsurgical treatment. With the state of the art EOS imaging system, on site physical therapy and bracing specialists, and multiple experienced providers who provide same day appointments, AHN is seeking to provide world class scoliosis care in a comfortable setting. We are committed to educating the community about scoliosis throughout the month of June and hope that you will also take some time to spread the word.