Screening for scoliosis: do we have indications for effectiveness?

Abstract

Objective: The effectiveness of screening for scoliosis has not been established. This study investigated whether patients with adolescent idiopathic scoliosis detected by screening are detected in an earlier stage of the clinical course, and whether these patients have better outcome than otherwise detected patients. Setting: The study is a retrospective follow-up study of patients with adolescent idiopathic scoliosis who had completed treatment with a brace, by surgery, or with a brace followed by surgery. Of the 143 patients (born on or after 1 January 1984) consecutively recruited from 12 hospitals in the Netherlands, 125 (87%) agreed to participate. Of these, 51 patients were treated with a brace only and 74 patients were operated on. Screening for scoliosis is carried out in 80% of Dutch children. Methods: Data on being screen detected or otherwise detected and Cobb angle at diagnosis were collected using youth health-care files, medical files and interviews by telephone with the patients. Results: About 55% of the patients were detected by screening (programme sensitivity). Screen-detected patients had a significantly smaller Cobb angle at diagnosis (28° versus 40°; P<0.01) and had a 73% lower chance of having had surgery (45% versus 75%; P<0.01) than otherwise-detected patients. Conclusion: In the present study, two essential prerequisites necessary for a screening programme for scoliosis to be effective have been met. However, definite proof of the effectiveness of screening still needs to be established because length bias and over-treatment bias cannot be ruled out using this design.

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

“…The relatively low sensitivity (55%) of the screening program 12 could perhaps explain why we did not find a beneficial effect. Furthermore, low levels of compliance with brace treatment could lead to ineffective treatment with a brace, which could result in more operations.…”

“…12 However, overtreatment bias and length-biased sampling could not be ruled out. In the present study, we also found that screen-detected patients were diagnosed in an earlier stage and had a greater chance of being treated with a brace.…”

“…12 However, overtreatment bias and length-biased sampling, leading to overestimation of the effect of screening, could be serious problems in such a study. 12,13 The present study investigated the effect of screening for scoliosis on reduction of the need for surgery. From a methodologic viewpoint, a RCT is the best design to establish the effectiveness of screening for scoliosis.…”

Prevalência de escoliose idiopática e variáveis associadas em escolares do ensino fundamental de escolas municipais de Cuiabá, MT, 2002

“…É uma deformidade da coluna, da caixa torácica e da cintura pélvica [3][4][5] . Como o próprio nome indica, a etiologia da escoliose idiopática da adolescência é desconhecida e descrita como multifatorial, e diversos estudos têm mostrado que sua prevalência é maior no sexo feminino 2,[5][6][7][10][11][12][13][14] . Em geral, seu diagnóstico é feito por exclusão 2 .…”

“…Exames rotineiros para detecção de deformidades na coluna vertebral em crianças e adolescentes são de fundamental importância para o diagnóstico precoce, quando a maioria dos casos não demanda tratamento cirúrgico 1,16 . Bunge et al 14 , em uma análise retrospectiva, compararam os resultados dos pacientes diagnosticados por seleção escolar com os daqueles diagnosticados por outros meios (familiares, serviço médico etc. ), e concluíram que os primeiros eram significativamente mais jovens, ou os que necessitaram cirurgia foram operados mais precocemente e tinham curvas menores.…”