Although Scoliosis awareness month is now over, we wanted to take one last opportunity to highlight the importance of a subject which is dear to our heart at the clinic – scoliosis screening. It’s a simple step that we can all take to avoid the risk of serious scoliosis, yet it something that most people are still unaware of.
Why screening matters
Scoliosis screening is quick, easy – and in many countries, it’s done as standard by general health practitioners and in schools. Today, most scoliosis clinicians agree that school screening for scoliosis in the UK would be a positive step to take since, for relatively little cost, significant benefits can be obtained for the majority of patients. It’s not just schools either – Chiropractors and other health professionals could help by learning some basic screening steps, or even just by encouraging people to use a free screening app.
It’s for this reason that scoliosis screening is considered a beneficial stage of treatment amongst the Orthopaedic community, as it is reported in the Consensus Paper which has been published by the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT).[1]
So why aren’t we all screening?
There are three main reasons which explain the lack of widespread screening in the UK. The first is simply the fact that many health professionals have little or no training on Scoliosis, and the general public has even less. So why is this the case? It goes back to the second main reason – the belief held for much of history, that scoliosis is treatable only with surgery and, therefore, that screening was of little value.
Until recently, this has been a valid point – but it’s critical to recognise that today there are far more options for scoliosis sufferers, and we’re now able to help many patients overcome scoliosis without ever thinking about surgery. Much of the evidence suggesting scoliosis can only be treated with surgery dates as far back as the 1940s[2] so it makes sense for us to re-examine the evidence and technology we now have available.
This is all the more important given the results of large scale studies, such as the BRAiST study in 2013[3], in which 58% of untreated patients had curves greater than 50° at skeletal maturity, while only 25% of patients treated with a scoliosis brace reached curves over 50°. This meant there was a 56% reduction of relative risk to surgery levels in braced patients and treatment costs for braced patients were less than those requiring surgery.
The third reason is cost – and the cost-based argument against screening also flows from the same line of thought – if surgery is the only treatment option, why invest in screening? Recent research has shown that scoliosis can be treated non surgically, and, in actual fact, we do now know exactly what scoliosis screening in schools would cost on an individualised basis – research carried out between 2000 and 2007 demonstrated that the direct cost for the examination of each child who participated in the program for the above period was just 2.04 €.[4] It is reasonable to suggest that costs today could be even lower!
Why we should screen
Aside from the fact that the arguments against screening no longer seem to stand up, it’s also clear that screening for scoliosis in schools, clinics and even through clubs and activities provides the best (sometimes only) opportunity for early diagnosis and therefore allows for non-surgical treatment, which is often not the case in the absence of screening[5].
In their most recently published joint information statement on scoliosis screening, the American Academy of Orthopaedic Surgeons, Scoliosis Research Society, Paediatric Orthopaedic Society of North America and American Academy of Pediatrics all agreed that there does not appear to be any significant medical reason not to screen for scoliosis[6].
Today there is significant evidence which shows that the number of scoliosis sufferers eventually requiring surgery can significantly be reduced where non-surgical treatment (such as scoliosis specific exercise, or bracing) is available on a high standard.[7] If we work from a modern viewpoint, rather than an outdated one, we can therefore see the real value of school screening. Indeed, school screening is often the only tool we have to detect mild and moderate spinal curves which can be easily treated with non-surgical methods.
The most recent research also confirms that this is more than just informed speculation – research does confirm that in areas where screening programs exist, fewer patients ultimately require surgery for scoliosis.[8]
In 2006, research from the University College Hospital and The London Clinic[9] assessed the severity of scoliosis presentation over 30 years. What the authors found was, that since mass school screenings were abandoned in the 1990s, in the year 2000 only 8% of patients had been identified at school compared to 32% in 1985 and that the number of patients presenting with curves greater than 40° had increased to 70%. This meant that for many of these patients non-surgical care would be less effective and the likelihood of requiring surgery was much greater. The author’s recommended that greater community awareness was required to enable earlier detection.
What you can do
The point of Scoliosis awareness month is to get people talking about scoliosis – but we shouldn’t let it end on June 30th – just by talking about scoliosis and raising the issue with people you interact with day-to-day, we can encourage more people to screen at home, more professionals to seek training on spotting scoliosis and perhaps even put pressure on the government to implement screening in schools. At Complete Chiropractic we screen all patients for scoliosis as part of our initial consultation, and we’d love to see other chiropractors do the same.
Thank you all for your support during Scoliosis awareness month 2021 – we hope next year to be able to do much more to support the event in a (hopefully) covid-free way!!
[1] TB Grivas, MH Wade, S Negrini, JP O’Brien, T Maruyama, M Rigo, HR Weiss, T Kotwicki, ES Vasiliadis, LS Neuhaus, T Neuhous, School Screening for Scoliosis. Where are we today? Proposal for a consensus. Scoliosis 2(1) (2007) 17
[2] AR Shands, JS Barr, PC Colonna, L Noall, End-result study of the treatment of idiopathic scoliosis. Report of the Research Committee of the American Orthopedic Association. J Bone Joint Surg 23A (1941) 963-977.
[3] BRAiST availible at: https://www.nejm.org/doi/full/10.1056/NEJMoa1307337
[4] TB Grivas, ES Vasiliadis, C Maziotou, OD Savvidou, The direct cost of Thriasio school screening program. Scoliosis 2(1) (2007) 7.
[5] WP Bunnel, Selective screening for scoliosis. Clin Orthop Relat Res 434 (2005) 40-5.
[6] Information Statement: Screening for idiopathic scoliosis in adolescents. American Academy of Orthopaedic Surgeons (AAOS), Scoliosis Research Society (SRS), Pediatric Orthopaedic Society of North America (POSNA) and American Academy of Pediatrics (AAP), October 1, 2007.
[7] M Rigo, C Reiter, HR, Effect of conservative management on the prevalence of surgery in patients with adolescent idiopathic scoliosis. Pediatr Rehabil 6(3-4) (2003) 209-14.
T Maruyama, T Kitagawa, K Takeshita, K Mochizuki, K Nakamura, Conservative treatment for adolescent idiopathic scoliosis: can it reduce the incidence of surgical treatment? Pediatr Rehabil 6(3-4) (2003) 215-9.
B Lee, The Correct Principles of Treatment of Angular Curvature of the Spine. 1872, Philadelphia, USA.
[8] T.B. Grivas et al. “How to Improve the Effectiveness of School Screening for IS” The Conservative Scoliosis Treatment (2008) p 120
[9] Detection of adolescent idiopathic scoliosis, Muhammad Ali Fazal, Michael Edgar, Acta Orthopaedica Belgica, 2006, 72, 184-186
