Catching scoliosis early with screening, and then taking appropriate action to stabilise and correct the cobb angle is the key to a successful outcome. Our message today, to parents in particular, is to have your children screened regularly and act on any concerns you may have. Unfortunately, many medical professionals today are still unaware of the non-surgical options for treating scoliosis and how effective they can be – unlike 20 years ago, today the prognosis is a good one.
Scoliosis school screening is vital
3 – 4 % of children will develop Scoliosis
Since Scoliosis usually develops in children and should be treated as soon as possible to maximise the chances of a successful outcome, school scoliosis screening has been a topic of much debate and is something that we strongly advocate here at the clinic.
Studies have shown that school screening can effectively reduce the risk of requiring invasive spinal
fusion surgery[1]. Although there has been debate about the effectiveness of school screening in the past, it is now clear that screening does improve outcomes for children affected by scoliosis. The clinical effectiveness of scoliosis screening has been assessed in numerous studies of different designs, which have been synthesized in a systematic review with clear results. The review covered 28 studies
published between 1977 and 2004 and concluded that there was sufficient evidence to suggest that school scoliosis screening is safe, may detect cases of Adolescent idiopathic Scoliosis (AIS) at early stages, and may reduce the risk of surgery[2].
Despite this, school screening is still not commonplace in the UK, although this is not the case everywhere. In Hong Kong, for example, scoliosis screening has been conducted as a routine health service since 1995, thereby making it one of the regions with the longest history of routine scoliosis screening in the world. Hong Kong’s screening protocol was demonstrated to be clinically effective for children who studied in the fifth grade during the first two academic years after the program was started; however, no longer term evaluation was attempted[3][4]. In response to this, a longer term study has now been undertaken, in which a total of 306,144 students participated in scoliosis screening. Clearly, screening is considered valuable around the world!
Why does early detection matter?
Early detection Is especially important in scoliosis cases since research has shown a direct link between the age of detection and the outcomes achievable. Today, through modern bracing technology, it has been demonstrated that conservative treatment with a brace is now highly effective in treating juvenile idiopathic scoliosis. In one recent study of 113 patients, the vast majority achieved a complete curve correction and only 4.9% of patients needed surgery.[5]
The 2015 study included patients aged between 4 to 10 years at the beginning of treatment and with a curve magnitude of 20°-40° Cobb. Curves between 20° and 25° Cobb degrees were included only in the presence of documented curve progression. Patients were prescribed an appropriate scoliosis brace and wear time, based on their individual cases.
The results from the study showed that curve correction was accomplished in 88 patients (77.8%), stabilization was obtained in 18 patients (15.9%). 7 patients (6.19%) have a progression and 4 of these were recommended for surgery. Critically however, the study also demonstrated that treatment appears to be more effective with curves under 30° (incidence of surgery: 1.6%) than curves over 30° (incidence of surgery: 5.5%) – which strongly suggests the need to catch curves early. [6]
Juvenile scoliosis almost never resolves without treatment
Scolibrace is a comfortable and effective advanced brace
Unfortunately, “wait and see” is still a common approach here in the UK – unfortunately this approach is outdated and fails to recognise the outcome of research which has clearly shown that juvenile scoliosis tends to worsen, sometimes aggressively and almost never resolves.
Research has demonstrated that Juvenile scoliosis greater than 30 degrees increases rapidly and presents a 100% prognosis for surgery, whereas curves from 21 to 30 degrees are more difficult to predict but can frequently end up requiring surgery, or at least causing significant disability[7].
A 2006 study followed (but did not treat) 205 patients of which 99 (48.3%) were operated on. Of 109 curves less than or equal to 20 degrees at onset of puberty, 15.6% progressed to greater than 45 degrees and were fused. Of 56 curves of 21 degrees to 30 degrees, the surgical rate increased to 75.0%. It was 100% for curves greater than 30 degrees[8].
This research is particularly troubling, in light of the above study, which showed a very high likelihood of total curve correction up to and including 30-degree angles, had these cases been screened, caught early and treated with a corrective brace.
How we can help
At the UK Scoliosis clinic, we offer free screening to anyone concerned about Scoliosis. If you have already had a diagnosis and have been advised to wait and see, we especially urge you to book an appointment to see our specialists in order to avoid compromising your chances at a highly effective treatment plan.
[1] Richards BS, Vitale MG. Screening for idiopathic scoliosis in adolescents. An information statement. J Bone Joint Surg Am 2008;90: 195–8.
[2] Sabirin J, Bakri R, Buang SN, Abdullah AT, Shapie A. School scoliosis screening programme—a systematic review. Med J Malaysia
2010;65:261–7.
[3] Luk KD, Lee CF, Cheung KM, Cheng JC, Ng BK, Lam TP, et al. Clinical effectiveness of school screening for adolescent idiopathic scoliosis: a large population-based retrospective cohort study. Spine
2010;35:1607–14.
[4] Yawn BP, Yawn RA, Hodge D, Kurland M, Shaughnessy WJ, Ilstrup D, et al. A population-based study of school scoliosis screening.
JAMA 1999;282:1427–32.
[5] ‘Brace treatment in juvenile idiopathic scoliosis: a prospective study in accordance with the SRS criteria for bracing studies – SOSORT award 2013 winner‘
Angelo G Aulisa, Vincenzo Guzzanti, Emanuele Marzetti,Marco Giordano, Francesco Falciglia and Lorenzo Aulisa, Scoliosis 2014 9:3 DOI: 10.1186/1748-7161-9-3
[6] ‘Brace treatment in juvenile idiopathic scoliosis: a prospective study in accordance with the SRS criteria for bracing studies – SOSORT award 2013 winner‘
Angelo G Aulisa, Vincenzo Guzzanti, Emanuele Marzetti,Marco Giordano, Francesco Falciglia and Lorenzo Aulisa, Scoliosis 2014 9:3 DOI: 10.1186/1748-7161-9-3
[7] Progression risk of idiopathic juvenile scoliosis during pubertal growth, Charles YP, Daures JP, de Rosa V, Diméglio A. Spine 2006 Aug 1;31(17):1933-42.
[8] Ibid.
