Abstract
Background
In the USA more than half the states have legislated scoliosis school screening with the remaining states having either voluntary screening or no recommendations. The four primary care providers for adolescents with idiopathic scoliosis in the USA (AAOS, SRS, POSNA, AAP) do not support any recommendation against scoliosis screening, given the available literature. In Australia a national self detection program is implemented but in the UK school screening has been abolished since the 1980's. Opponents to scoliosis screening have focused on concerns about a low predictive value of screening, the cost effectiveness of referral, the possibility of unnecessary brace treatment and the effect of exposure to radiation when radiographs are obtained.
Objectives
The purpose of this review was to evaluate the evidence for and against scoliosis screening.
Methods
The following databases were searched: Cochrane Library, ARIF, TRIP, MEDLINE, EMBASE and CINAHL. Reference lists of articles were searched for relevant systematic reviews and research articles.
Results
One systematic review (2008)1 suggests that there is evidence (level 1B) that intensive scoliosis specific exercise methods can reduce the progression of mild scoliosis (<30 degrees Cobb). Further a Cochrane review (2010)2 suggests that there is low quality evidence for the effectiveness of bracing.
Conclusions
Based on the evidence of this review, a 4 tier model for school screening is proposed that includes the distribution of information leaflets, screening by a school nurse, topographical assessment, referral to the primary care doctor and finally if the patient is still screening positive, referral to a scoliosis surgeon.
Category: Deformity/screening
Ethics approval: none needed for a review
Interest statement: none
