Screening for Adolescent Idiopathic Scoliosis

Abstract

IMPORTANCE Adolescent idiopathic scoliosis (AIS), a spinal curvature of 10°or more, is the most common form of scoliosis, with a prevalence of 1% to 3%. Curves progress in approximately two-thirds of patients with AIS before skeletal maturity, and large curves (>50°) may be associated with adverse health outcomes. OBJECTIVE To systematically review evidence on benefits and harms of AIS screening for the US Preventive Services Task Force (USPSTF). DATA SOURCES Cochrane Central Register of Controlled Trials, MEDLINE, ERIC, PubMed, CINAHL, and relevant systematic reviews were searched for studies published from January 1966 to October 20, 2016; studies included in a previous USPSTF report were also reviewed. Surveillance was conducted through July 24, 2017. STUDY SELECTION Fair-and good-quality studies that evaluated the accuracy of screening children and adolescents aged 10 to 18 years for AIS, the benefits of AIS treatment, the harms of AIS screening or treatment, or long-term health outcomes. DATA EXTRACTION AND SYNTHESIS Two investigators independently reviewed abstracts and full-text articles and extracted data into evidence tables. Results were qualitatively summarized. MAIN OUTCOMES AND MEASURES Health outcomes and spinal curvature in adolescence and adulthood, accuracy of screening for AIS, any harm of AIS screening or treatment. RESULTS Fourteen studies (N = 448 276) in 26 articles were included. Accuracy of AIS screening was highest (93.8% sensitivity; 99.2% specificity) in a cohort study of a clinic-based program using forward bend test, scoliometer, and Moiré topography screening (n = 306 082); accuracy was lower in cohort studies of 6 programs using fewer modalities (n = 141 161). Four controlled studies (n = 587) found evidence for benefit of bracing on curve progression compared with controls. A randomized clinical trial and a nonrandomized trial of exercise treatment (N = 184) found favorable reductions in Cobb angle of 0.67°to 4.9°in the intervention group compared with increases of 1.38°to 2.8°in the control group. Two cohort studies (n = 339) on long-term outcomes found that braced participants reported more negative treatment experience and body appearance compared with surgically treated or untreated participants. A study that combined a randomized clinical trial and cohort design (n = 242) reported harms of bracing, which included skin problems on the trunk and nonback body pains. There was no evidence on the effect of AIS screening on adult health outcomes. CONCLUSIONS AND RELEVANCE Screening can detect AIS. Bracing and possibly exercise treatment can interrupt or slow progression of curvature in adolescence. However, there is little or no evidence on long-term outcomes for AIS treated in adolescence, the association between curvature at skeletal maturity and adult health outcomes, the harms of AIS screening or treatment, or the effect of AIS screening on adult health outcomes.

Ahead of the Curve: Pediatric Scoliosis

“…The 2018 recommendations from the United States Preventive Services Task Force suggest that scoliosis may be identified with clinical examination with the Adams forward bend test, with scoliometer measurement or without, and with radiologic confirmation as appropriate. 1 Clinical monitoring may be used if patients have suspected or confirmed minimal curves. In this case, routine assessments, typically every 6 months, are adequate for at least the first observational period and while a child is having rapid spinal growth (generally during the adolescent growth spurt).…”

“…A child with any magnitude of scoliosis (defined as a curve of 10 degrees or more) on radiologic imaging should be referred to an orthopedic specialist if feasible. 1,4…”

“…It is the most common type of structural scoliosis, with a prevalence of 1% to 3%. 1 Currently available genetic testing, (ScoliScore; Axial Biotech, Inc., Salt Lake City, Utah, USA) fails to predict progression, is not covered by commercial insurance, and is therefore not recommended. 22 Idiopathic scoliosis may present at any age, although it presents most commonly in those over 10 years of age.…”

“…Scoliosis is traditionally defined as a lateral curvature of the spine of 10 degrees or more 1 (Figure 1). 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.…”

Analisis of posture in school-age children according to optical topography

“…2019, №4 43 Введение. Частота встречаемости нарушений осанки у детей школьного возраста, по данным литературы [1][2][3], составляет от 10 до 80%. Высокая вариативность показателя может быть связана с использованием клинического метода в качестве основного, однако визуальный осмотр не обладает достаточной эффективностью [4].…”