Screening for idiopathic scoliosis in adolescents: An information statement

Many states mandate school screening to identify children at risk for scoliosis, though recent studies have cast some controversy on the effectiveness of routine scoliosis screening. Previous studies have both supported and discouraged routine screening. Prevention of severe scoliosis is a major commitment of physicians caring for children with spinal deformities. For this reason, the American Academy of Orthopaedic Surgeons (AAOS), the Scoliosis Research Society (SRS), the Pediatric Orthopaedic Society of North America (POSNA), and the American Academy of Pediatrics (AAP) convened a task force to examine issues related to scoliosis screening and to put forth the present information Statement. The societies acknowledge the important role of a systematic review of the literature as well as the role of consensus expert opinion in the common situation where the available evidence does not yet exist to speak definitely for, or against, an evaluation or intervention. Costs involved with scoliosis screening are relatively low on a societal level and may justify the possibility of preventing surgery in adolescents with scoliosis. Adolescents without significant spinal deformity who are referred to a specialist for evaluation often do not require radiographs. For those who do need radiographic evaluation, it is important to know that the radiation exposure using current-day radiographic techniques, including digital radiography, is significantly smaller than in the past. Opponents to scoliosis screening have focused on concerns about a low predictive value of screening and the cost-effectiveness of referral. There have also been concerns about the possibility of unnecessary treatment, including brace use, and the effect of exposure to radiation when radiographs are obtained. With regard to early treatment in those adolescents detected with moderate scoliosis, the available data neither definitively support nor refute the efficacy of bracing. To most effectively answer this, a well-organized level 1 study is needed. Such a study, a five-year multicenter randomized controlled trial of bracing sponsored by the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIH/NIAMS), is currently under way. In 1996, the United States Preventive Services Task Force (USPSTF) concluded that there was insufficient evidence to make a recommendation for, or against, screening. However, in 2004, the USPSTF changed their position and recommended against the routine screening of asymptomatic adolescents for idiopathic scoliosis. The AAOS, SRS, POSNA, and AAP have concerns that this change in position by the USPSTF came in the absence of any significant change in the available literature, in the absence of any change in position statements by the AAOS, SRS, POSNA, and AAP, and in the absence of any significant input from specialists who commonly care for children with scoliosis. As the primary care providers for adolescents with idiopathic scoliosis, the AAOS, SRS, POSNA, and AAP do not support any recommendation against scoliosis screening, given the available literature.