Screening

School screening

Traditionally, school screening programes have been widely instituted in many areas of the world in order to identify scoliosis at an early stage and thus avoid surgical treatment that may be necessary following later presentations. These programmes are typically part of a routine annual physical examination undertaken between 10 and 12 years of age.

However, in order for scoliosis screening to be justified, an effective early treatment must be available. Previously there was borderline evidence regarding the efficacy of brace treatment, with many experts questioning the cost-effectiveness of scoliosis screening.[40][41][42][43] Additionally, one systematic review by the US Preventive Services Task Force found insufficient evidence to assess the benefits or harm of screening for AIS.[30]

On the other hand, the Scoliosis Research Society recommends routine screening for school- aged children, citing findings from the BrAIST (Bracing in Adolescent Idiopathic Scoliosis Trial) trial, which better elucidates the efficacy of bracing in AIS.[44][45]

Despite this doubt, screening programmes have helped to increase the awareness of scoliosis among paediatricians and primary care physicians. Additionally, many experts feel that screening programmes provide the opportunity for early detection of scoliosis in at-risk populations.[46][47][48][49]

Adams' forward bend test

Forward bending at the waist (viewed from anterior, posterior, and lateral aspects) provides a good perspective for identifying thoracic, thoracolumbar, or lumbar paraspinal and thoracic cavity prominences (which result from abnormal vertebral rotation as well as a combination of abnormal spinal curvature in the coronal and sagittal planes). Bending forward accentuates paraspinal and rib prominences, suggestive of a diagnosis of scoliosis.[1][2]

This is the hallmark examination finding that leads to a suspicion of scoliosis during screening evaluation. A positive result is observation of an asymmetric paraspinal prominence. The presence of an asymmetric scapular prominence may suggest an upper thoracic curve.[34]

This test has been shown to have reasonable intra- and interobserver reliability.[1][2]

Scoliometer measurement

Although not routinely undertaken in the general population, scoliometer measurement allows quantification of the paraspinal prominences found by Adams' forward bend test.

A positive result is one of >5° at any paraspinal prominence (thoracic or lumbar). Although scoliometer measurements do not exactly represent Cobb angle measurements from plain film radiographs, the 2 values may correlate with one another. In general, scoliometer measurements of 5° and 7° correspond to a measured Cobb angle of approximately 10° and 20°, respectively.[35][36] This correlation makes scoliometer measurements useful as they represent commonly agreed-upon cut-off points used to direct treatment decisions.

It has been shown that a scoliometer reading of 5° has a sensitivity of 100% and a specificity of 47% for the detection of adolescent idiopathic scoliosis. Based on this data, a patient with a scoliometer reading of <5° does not warrant further evaluation with plain film radiographs. However, a scoliometer reading of 7° has a sensitivity of 83% and a specificity of 86% and thus warrants further evaluation with plain film radiographs and referral to a spinal deformity specialist.[35][36][Figure caption and citation for the preceding image starts]: Scoliometer measurement of a right thoracic prominenceWeinstein SL, et al. Adolescent idiopathic scoliosis. Lancet. 2008;371:1527-1537. Used with permission [Citation ends].com.bmj.content.model.Caption@46abfd90

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