Medical Health Encyclopedia

Screening programs for scoliosis, which began in the 1940s, are now mandatory in middle or high schools in many states, but there is considerable debate over whether screening should be routine.

Arguments Against Routine Screening

US Preventive Services Task Force does not recommend routine screening to detect adolescent scoliosis for the following reasons:

• Screening tests are not accurate and depend too much on the skill of the examiner.
• Schools often refer children with minor curves who are not at any risk for a progressive or serious condition to physicians, and such over-referrals add considerably to the costs of the health system. In one major 1999 study, 94% of the children referred to a physician by the school did not require treatment. (Over 2,000 children were screened in order to find only five children who did need treatment.)
• A long-term study of untreated patients with late-onset scoliosis indicates that these patients are productive and functional at a high level at 50-year follow-up. Patients with scoliosis have no greater danger for significant lung problems than the general population until their curves reach 60 to 100 degrees, making early screening unnecessary.
• At the time of the Task Force, studies were also showing no benefits from the early treatments, specifically braces.

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Experts against screening argue, then, that such programs result in early treatments that either will not prevent curve progression and surgery or are unnecessary in the first place since curvatures often do not progress at all.

Arguments for Routine Screening

The American Academy of Orthopaedic Surgeons recommends that girls be screened twice, at ages 10 and 12, and that boys be screened once at 13 or 14. The American Academy of Pediatrics recommends, however, scoliosis screening at ages 10, 12, 14, and 16 years. (In one study, over 40% of high school sophomores with newly diagnosed scoliosis had shown no signs of the disorder in earlier screening tests.) Other experts make the following arguments for universal screening:

• Universal screening is useful for producing information on scoliosis that may eventually lead to knowledge of its cause and ways to prevent it.
• Braces have been proven to be effective since the task force's recommendation and early treatment can be important.
• Without screening, the chances are slim that children with scoliosis will be diagnosed at an early stage if they can only rely on examinations by a family physician or pediatrician. Such physicians often do not even look at backs and, if they do, they tend to use only the forward bend test, which is not accurate.