Prevention of severe scoliosis is a major commitment of orthopaedic surgeons. In August 1984, the American Academy of Orthopaedic Surgeons issued a position statement strongly endorsing the concept of school screening for the early detection of scoliosis in children. Scoliosis is a spine deformity characterized by lateral and rotational curvature of the spine. The deformity usually develops during the preadolescent years. In most patients the cause is still unknown and thus the deformity is labeled "idiopathic." In those patients in whom a cause can be identified, neuromuscular disease or congenital abnormality of the spine are the most common findings. The number of adults affected with a significant scoliotic deformity is estimated to be several hundred thousand.
The purpose of school screening is to detect scoliosis at an early stage when the deformity is mild and likely to otherwise go unnoticed. It is at this early stage that bracing programs may be effective in halting progression of the deformity and thus prevent the need for surgical treatment. In addition, the children with more significant scoliosis, who often have no other symptoms, may be detected at a time when surgical treatment is more effective.
The American Academy of Orthopaedic Surgeons and the Scoliosis Research Society continue to support the principle of school screening for scoliosis.
Although its predictive value has not been established to the satisfaction of all, scoliosis screening has been an important factor in improving knowledge about this spinal deformity. Refinements in screening techniques have been made since 1984 and, as knowledge about scoliosis is gained, additional modifications may be necessary.
School screening for scoliosis has expanded rapidly during the past decade and has been important in improving the understanding of this incompletely understood spine deformity. As a result, it is now possible to target more precisely the age at which screening is most beneficial. Because girls achieve adolescence about two years before boys and because girls are afflicted with a magnitude of scoliosis requiring treatment about three to four times more frequently than boys, different screening guidelines are emerging for girls and boys. While the optimum age for screening has not been established with certainty, a reasonable approach would be to screen girls twice, at 10 and 12 (grades 5 and 7), and boys once, at age 13 or 14 (grades 8 or 9). The American Academy of Orthopaedic Surgeons and the Scoliosis Research Society believe that school screening personnel should be educated in the detection of spinal deformity.
Screening should always include the forward bending test, the most specific test for true scoliosis, but no single test is completely reliable for screening. Therefore, considerable judgment on the part of the screener is necessary to achieve an appropriate referral rate and to avoid unnecessary referrals. To meet the objective of the screening program, the American Academy of Orthopaedic Surgeons and the Scoliosis Research Society recognize the need to keep the referral of students to a minimum.
The American Academy of Orthopaedic Surgeons and the Scoliosis Research Society maintain their commitment to avoid the inappropriate use of spine x-rays.
Not all children referred as a result of screening require x-rays. If x-rays are needed, physicians should take necessary precautions to limit the patient's exposure to radiation.
Educational materials which provide more specific guidelines for conducting school screening programs for scoliosis are available to physicians and school authorities. Further information may be obtained from the Academy and the Scoliosis Research Society,
6300 N. River Rd., Rosemont, Ill. 60018.
Scoliosis Research Society
© July 1984 American Academy of Orthopaedic Surgeons
Revised October 1987, July 1992
This material may not be modified without the express written permission of the American Academy of Orthopaedic Surgeons.
Document Number: 1122
For additional information, contact Alvin Nagelberg at (847) 384-4138 or email nagelberg@mac.aaos.org