Scoliosis detection, patient characteristics, referral patterns and treatment in the absence of a screening program in Norway

Abstract

BackgroundEarly diagnosis of idiopathic scoliosis allows for observation and timely initiation of brace treatment in order to halt progression. School scoliosis screening programs were abolished in Norway in 1994 for lack of evidence that the programs improved outcome and for the costs involved. The consequences of this decision are discussed.ObjectivesTo describe the detection, patient characteristics, referral patterns and treatment of idiopathic scoliosis at a scoliosis clinic during the period 2003–2011, when there was no screening and to compare treatment modalities to the period 1976–1988 when screening was performed.MethodsPatient demographics, age at detection, family history, clinical and radiological charts of consecutive patients referred for scoliosis evaluation during the period 2003–2011, were prospectively registered. Patients were recruited from a catchment area of about 500000 teenagers. Maturity was estimated according to Risser sign and menarcheal status. Severity of pain was recorded by a verbal 5-point scale from no pain to pain at all times. Physical and neurological examinations were conducted. The detector and patient characteristics were recorded. Referral patterns of orthopedic surgeons at local hospitals and other health care providers were recorded. Patient data was obtained by spine surgeons. Treatment modalities in the current period were compared to the period 1976–1988.ResultsWe registered 752 patients with late onset juvenile and adolescent idiopathic scoliosis from 2003–2011. There were 644 (86%) girls and 108 (14%) boys. Mean age at detection was 14.6 (7–19) years. Sixty percent had Risser sign ≥ 3, whilst 74% were post menarche with a mean age at menarche of 13.2 years. Thirty-one percent had a family history of scoliosis. The mean major curve at first consultation at our clinic was 38° (10°-95°). About 40% had a major curve >40°. Seventy-one percent were detected by patients, close relatives, and friends. Orthopaedic surgeons referred 61% of the patients. The mean duration from detection to the first consultation was 20(0–27) months. The proportion of the average number of patients braced each year was 68% during the period with screening compared to 38% in the period without screening, while the proportion for those operated was 32% and 62%, respectively ( p=0.002, OR 3.5, (95%CI 1.6 to 7.5).ConclusionIn the absence of scoliosis screening, lay persons most often detect scoliosis. Many patients presented with a mean Cobb angle approaching the upper limit for brace treatment indications. The frequency of brace treatment has been reduced and surgery is increased during the recent period without screening compared with the period in the past when screening was still conducted.

IDENTIFICATION OF SNPs IGF-1 GENE IN VERTICAL MANDIBULAR ASYMMETRY PATIENTS WITH IDIOPATHIC SCOLIOSIS SYMPTOM

“…Previous studies reported that difference in ramus length and anterior nasal spine-menton angles showed a statistically significant correlation (p<0.05) to the difference of coracoid height, clavicular angle, radiographic shoulder height, and clavicle-rib intersection [19,20,29]. Class II division 1 malocclusion was a common malocclusion in idiopathic scoliosis subjects that had a significant effect on the condylar asymmetry index compared to other malocclusions [30].…”

Effect of Preoperative Indications Conference on Procedural Planning for Treatment of Scoliosis

“…Correction of the spinal deformity, achievement of a balanced posture, and preservation of spinal mobility are the primary goals of surgical treatment [16]. Surgery for AIS is indicated in patients with thoracic curves that are predicted to progress to greater than 45 to 50 degrees by the time of skeletal maturity [17,18]. Surgery for EOS is indicated in patients with coronal curves greater than 60 degrees with progression, and those patients with anticipated progression in which nonoperative treatments have either failed or are contraindicated [19].…”

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

“…The FBT was always used, and a specially trained nurse assisted in the screening. Sweden is the only Scandinavian country with an ongoing SSS [2,34] .…”

“…Adolescent idiopathic scoliosis (AIS) is a complex three dimensional developmental deformity of the spinal column and associated rib cage characterized by a lateral deviation and axial rotation [1,2,3] . The diagnostic criterion is a lateral curvature of the spine measuring at least 10° on an X-ray as determined by the Cobb method [4] .…”