Scoliosis Screening The overall incidence of scoliosis or curvature of the spine in the general
population for kids greater than 14 years of age is about 1.5 percent. This
figure refers to curves that measure greater than 10 degrees. Severe curves
of greater than 30 degrees occur in about 0.2 percent of the general population.
A closer look at the population at risk indicates that the greatest risk of
developing scoliosis occurs in adolescent females, who are five times more likely
to have a curve that needs treatment than their male counterparts.
The significant incidence of scoliosis in the adolescent population has prompted
the creation of school screening programs in all 50 states. The role
of school screening is to detect the disease at a stage where early detection
will influence positively the outcome of the problem (ie) avoid surgery. To
be effective, the test should be both sensitive (always detect
the presence of scoliosis versus a normal back) and specific (find
scoliosis as opposed to other problems) and have a low false negative rate (doesn't
miss kids that need treatment). The test has to be easy to perform by multiple
examiners with minimal training. Ideally, the outcome of screening programs
should confirm that early detection has influenced positively the incidence
of kids needing surgery. There is some controversy about the current method
of school screening actually meeting these goals. For example, only one-fourth
of children referred for evaluation of suspected scoliosis actually need treatment!
This "over-referral" raises the question of the cost-effectiveness of screening
programs.
The test for scoliosis screening is simple. Most parents are capable
of doing the screening test with a high degree of accuracy. The standard test
for scoliosis is termed the Adam's Forward Bend Test. Kids are asked
to bend over at the waist as if they were touching their toes. The examiner
gets their eyes level with the back and looks for one side being higher than
the other, or any asymmetry of the back. Even parents with no medical training
can detect relatively small curves if they look carefully.
If scoliosis screening is so easy, then why do kids show up with large curves
on their first visits to the orthopedic surgeon? The simple answer is that most
of the kids at risk are at a stage of their development where they have become
modest, private people. It is surprisingly difficult to detect scoliosis under
the standard loose clothing that teenagers wear currently. We encourage all
parents to look at their adolescent children's backs periodically during their
growth spurts, in a setting where they are comfortable. If you suspect scoliosis,
then we would recommend further evaluation by your physician.
The initial evaluation by your physician will begin with a simple physical
exam. If scoliosis is suspected, it is confirmed by taking an x-ray. Make sure
that the x-ray that is taken is adequate for initial evaluation of scoliosis.
This should be an x-ray that includes the entire spine and the top of the pelvis,
taken in the standing position. Once the x-ray is taken, it is important to
ask your physician the following questions:
- Do I have scoliosis?
- What does my curve measure?
- Can you tell if I still have growth to go?
- Do I need to see a specialist about this or is it safe to wait a while?
Commonly Asked Questions about Scoliosis Screening:
- Will I have to get undressed in front of other kids?
No. The examiner will need to look at your back. This does involve pulling
up your shirt from behind and bending over, but not completely undressing.
Most examiners will be sensitive to your modesty. Boys are usually screened
in a different location from girls for privacy reasons.
- Does it hurt?
No. This is a painless test.
- How will I know if my test is "positive"?
If the examiner thinks that you have a curvature of the spine, he or she
will give you a form to take home to your parents. This form usually includes
a recommendation to see your doctor for a closer examination of your back.
The examiner will give you a form to take to your doctor for him or her to
sign and return to school to document that you had an examination.
- If I have a "positive" test for school screening, does it mean that I will
have to wear a brace or have surgery?
Not necessarily. Only one-fourth of kids with a positive school screening
test end up needing treatment of any kind, so the news that you get from your
doctor is usually good. However, only your doctor can make this determination.
You should definitely not avoid your doctor because you are fearful that you
may require treatment.
Take the online
self-assessment test.
The materials on this Web site are for your general educational information only. Information you read on this Web site cannot replace the relationship that you have with your health care professional. We do not practice medicine or provide medical services or advice as a part of this Web site. You should always talk to your health care professional for diagnosis and treatment.
| Published: December 19, 2001 |
Updated: February 07, 2008 |
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