Published 11/1/2007
Mary Ann Porucznik

AAOS endorses scoliosis screening statement

The AAOS has joined the Scoliosis Research Society (SRS), the Pediatric Orthopaedic Society of North America (POSNA), and the American Academy of Pediatrics (AAP) in endorsing an information statement about screening for idiopathic scoliosis in adolescents. The statement, which was authored by B. Stephens Richards III, MD, and Michael G. Vitale, MD, is called an educational tool and not the product of a systematic review.

Although the statement does not go so far as to recommend school screening programs, it does encourage the continuation of such programs where they currently exist. It also states that the endorsing organizations would not support any recommendations against screening.

A controversial step
The authors point out that “routine clinical screening for scoliosis continues to be controversial, with less than half of the states in the United States currently legislating school screening.” After reviewing several studies with differing conclusions, the authors note that “definitive conclusions regarding the effectiveness of scoliosis screening cannot be made from the available evidence in the literature.”

In 2004, however, the U.S. Preventive Services Task Force recommended against the routine screening of asymptomatic adolescents for idiopathic scoliosis. According to the statement, “As the primary care provider for adolescents with idiopathic scoliosis, the AAOS, the SRS, the POSNA, and the AAP do not support any formal recommendations against scoliosis screening, given the available literature.”

Early diagnosis of scoliosis has potential benefits. The statement recommends that scoliosis screening programs screen girls twice (at ages 10 and 12 or grades 5 and 7) and boys once (at age 13 or 14 or grade 8 or 9). Screening should always include the forward-bending test, and school personnel who conduct the screenings should be educated in the detection of spinal deformity. It also restates the organizations’ commitment to avoid inappropriate use of spine X-rays.

“If the program is already in place,” said Dr. Richards, “it should continue; there’s no evidence in the available literature to recommend against it.”

Providing common ground
“This statement provides a common ground for a wide range of physicians, as well as for patients,” said Dr. Richards, who is a member of the SRS board of directors as well as president-elect of POSNA. “We can all quote the same document.”

The document is the result of a task force convened by the AAOS, SRS, POSNA, and AAP to examine issues related to scoliosis screening. The information statement provides material to patients, physicians, and decision makers regarding screening (defined as a clinical, rather than radiologic, examination) for scoliosis.

“The statement was written to voice a consensus opinion of clinicians in the field who have experience in the diagnosis and treatment of children with scoliosis,” explained Dr. Vitale. “We were concerned that the previously published report from the U.S. Preventive Task Force may have had untoward consequences for children with scoliosis. Although our information statement is not an evidence-based review, rigorous evidence in this area is lacking. In this light, we feel that there is a role for an information statement that voices consensus expert opinion. We hope that dissemination of this statement will bring the issue to the attention of those clinicians who have the opportunity to diagnose this condition at an early stage.”

The entire statement will be published in the Journal of Bone and Joint Surgery early in 2008 and will be posted to the endorsing organizations’ Web sites.