Screening for Scoliosis

Scoliosis is a common condition and affects approximately 3% of the general population worldwide. Girls are affected 5 times as commonly as boys. Most people have mild curves which do not require operative intervention. However, 10% to 20% of all scoliotics, or approximately every 3 out of 1000 people have scoliosis severe enough to require surgery. In the USA, approximately 38000 children undergo surgery every year for this condition. An equal number undergo bracing (Population of USA is 305 million).

In children who have scoliosis, it is extremely important to identify the condition very early.
Early treatment, (before the curves become severe), is extremely beneficial to the child and gives a good long-term result.

Children who present with severe deformity in advanced stages of the disease need extensive surgery and suffer a much higher morbidity.

Scoliosis does not lead to cosmetic deformity alone; Scoliosis, if left untreated, results in diminished pulmonary function due to poor lung development, restrictive lung disease, decreased cardiac function and limitation of physical ability. Untreated scoliotics have a high incidence of degenerative spine disease by the 5th decade of life. Larger spinal curves (above 40 degrees) tend to progress even after cessation of growth, and become severe as the patient ages.

Early detection is imperative for successful treatment. A curve cannot be corrected except by surgery, so it is important that the curve is not allowed to progress.

How to Screen for Scoliosis

Since early intervention has such huge benefits for a child suffering from scoliosis, it becomes imperative to screen all susceptible age groups for scoliosis . Thankfully, screening is a simple procedure, and the steps are as follows

• Make the child stand up and face away from you. You should sit or stand behind the child.
• Ask the child to bend down and touch their toes keeping the knees straight.
• Watch the symmetry of the back . A child with scoliosis will show an apparent “hump”. A mild case will show a difference in the level of the 2 sides of the back.

This test is called the Adam’s forward bending test. A positive finding is an indication for an Xray whole spine PA standing and a referral to a scoliosis specialist.

Other findings may be evident ( See the pictures below):

• The child or adolescent may lean to one side when standing.
• One shoulder may be higher than the other.
• One hip may be higher.
• One leg appears shorter.
• The child may have a deep depression (or dent) on one side of the waist.

Bracing is effective in early scoliosis:

Always screen your patients / children who are 9 years and above. Early detection will make non-surgical treatment possible.