School Scoliosis Screening Programs

Should Schools Screen Kids for Scoliosis

When you hear the word "deformity," you may think of hidden-away characters in movies -- certainly not something that could affect your healthy child. But any sideways curve in the spine - known as scoliosis - is considered a deformity. A spine with scoliosis takes on a curve that resembles the letters C or S; normally, the spine looks like the letter I.

Catching and managing it early will usually prevent it from progressing to an extreme degree.

That's where the discussion of school scoliosis screening programs comes in.

Current Status

About half of U.S. states have mandatory scoliosis screening in their schools. Evidence and expert opinion is pretty much split down the middle as to how useful these programs are.

In 1996, the U.S. Preventative Services Task Force reviewed all of the studies that had been done on the topic of scoliosis screening programs and concluded they should not be recommended. But in 2008, a task force consisting of four medical associations -- the American Academy of Orthopedic Surgeons, Scoliosis Research Society, Pediatric Orthopedic Society of North America, and the American Academy of Pediatrics -- issued a position statement stating that they would not support any recommendation against school screenings.

Their statement represents a doctor's point of view. They believe that scoliosis screening programs help detect this deformity early, which in turn, can help prevent unnecessary back surgeries.

Also, in poor or under served neighborhoods, school-based scoliosis screenings may be the child's only chance to get the help they need in a timely fashion.

Background

Scoliosis is an abnormal side-to-side curve of the spine. There are numerous causes of scoliosis including neurological diseases, musculoskeletal problems or inherited connective tissue disorders, but most of the time, the cause is unknown.

Scoliosis with an unknown cause is called idiopathic. Idiopathic scoliosis is classified according to the age of the child when the deformity first starts:

  • Early onset scoliosis begins at or before age three.
  • Juvenile scoliosis begins between three and ten years.
  • Adolescent scoliosis begins between age ten and when the skeleton matures.

You may be able to detect scoliosis in your child if you know what to look for, but many parents miss the signs. Screening programs are designed to pick up on scoliosis while the child is still young enough to significantly benefit from treatment.

Recognize the Need to Screen

The Institute for Clinical Systems Improvement (a group that produces research-based guidelines for treating medical conditions) says that the decision to screen for scoliosis should be left to you, your doctor and/or the medical office you go to for health services. They say that screening programs may be impractical because they are not necessarily cost effective. Again, experts are not sure if screening programs are all that good at predicting the onset of scoliosis.

In other words, is providing a scoliosis screening program in the school worth the effort? Does it really work? Many experts are not convinced.

But the earlier you catch scoliosis in your child, the more likely it is you'll be able to avoid surgery. Identifying the signs of a scoliosis is the first pro-active step toward halting the progression of the curve(s).

In my opinion, you should take advantage of every opportunity that's available to you to detect this condition. This may include screening at your school, or it may not. Other avenues include asking your family doctor to screen your child and learning how to look for scoliosis yourself. If you take advantage of these options, you can reduce the risk of missing scoliosis that's there.

Often, the signs of scoliosis aren't obvious until the child's growth spurt occurs. Experts recommend that girls get screened twice, at ages 10 and 12, and that boys get screened once between the ages of 13 and 15.

(Girls are at higher risk for scoliosis than boys, especially for large curves.) It pays to remain alert to changes in your adolescent's posture in general. If you notice the signs or anything "off" about their posture, ask your doctor for a screening.

What Happens After Screening?

If the school screening doesn't detect scoliosis, the only follow-up you need is to continue your detection efforts.

Keep watching your child's posture. And if your pediatrician doesn't do a screening during your routine check-up, initiate the process by asking her about it.

If the school screening shows the possibility of scoliosis, you will be referred to a doctor for a diagnosis. At the very least, the doctor will take an x-ray. She will calculate the Cobb Angle from the x-ray -- a measurement of the degree of side-to-side spinal curvature.

Decision as to which treatment course to take is largely based on the Cobb Angle. If it is 15 degrees or less, it's likely that regular check-ups are all that's needed. These check-ups are to monitor the curve(s) for progression. If the Cobb Angle is between 20 and 40 degrees, a back brace may be necessary to stop the curve from progressing. If it is over 40 degrees, your doctor will likely recommend surgery to straighten the spine.

Where It Stands

When it comes to scoliosis treatment, time is of the essence. Whether you're alerted to the possibility of scoliosis by the results of school screening program, a routine check-up at the doctor's or your own astute observations, the earlier you get it diagnosed, the sooner you can address it with treatment.

For some people, early treatment is the determining factor in avoiding major spine surgery. In most cases, it can help stop the curve from getting worse, and help your child to avoid developing an obvious deformity.

Sources:

Richards,SB, Vitale, MG. Screening for Idiopathic Scoliosis in Adolescents. An information statement. J Bone Joint Surg Am 2008.

Scoliosis Research Society. Fact Sheet. Scoliosis Media and Community Guide. Accessed: May 2010.

U.S. Preventive Task Forst (USPSTF).Screening for Idiopathic Scoliosis in Adolescents Recommendation Statement. AHRQ. Accessed: May 2010.

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