Orthopedic, pediatric, scoliosis societies call for early scoliosis detection

Recent high-quality evidence confirming the effectiveness of early screening and appropriate treatment for scoliosis has led to a revised position statement from several orthopedic and pediatric organizations.

Perspective from Stuart L. Weinstein, MD

After a review of results from the NIH-funded study “Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST),” the American Academy of Orthopaedic Surgeons (AAOS), the American Academy of Pediatrics, the Pediatric Orthopaedic Society of North America and the Scoliosis Research Society recently issued a joint statement supporting the need for early scoliosis detection. The joint statement is entitled “Screening for the Early Detection of Idiopathic Scoliosis in Adolescent.”

“The BrAIST study provided high-quality evidence that bracing for adolescent idiopathic scoliosis can decrease the rate of progression of spinal curve to the surgical level,” M. Timothy Hresko, MD, co-author of the revised statement, said in a press release from the AAOS. “Early detection of scoliosis is essential to identifying patients who may benefit from the use of a spinal brace. The new, 2016 joint position statement — released jointly by four prominent child health organizations — reflects the importance of early scoliosis detection.”

According to the press release, the organizations now support screening examinations for spine deformity as part of medical home preventive care visits for girls at age 10 years and at age 12 years. For boys, the organizations support these examinations once at age 13 years or 14 years. The revised statement from the groups recommends that screening programs should be performed by well-trained personnel who can appropriately administer forward bending tests. Personnel should use a scoliometer to correctly measure and identify abnormal spine curvature, and refer children to professionals for additional testing and imaging as needed. The organizations also support bracing as an effective nonoperative intervention to reduce the risk of progression to surgical treatment and stressed that any imaging tests should follow As Low as Reasonably Achievable standards to minimize radiation exposure in young patients.

Reference:

www.aaos.org

Perspective

Stuart L. Weinstein, MD

The Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST) study give patients affected by adolescent idiopathic scoliosis and who are at high risk of curve progression, level 1 evidence that appropriate bracing can prevent the curve from reaching a degree where surgery would be needed. This high-level evidence makes it imperative that primary care health care providers need to incorporate a scoliosis screening exam into their routine patient evaluations so that affected children can be promptly referred for treatment.

Reference:

Weinstein SL, et al. N Engl J Med 2013; doi:10.1056/NEJMoa1307337.

Stuart L. Weinstein, MD

Ignacio V. Ponseti Chair and Professor of Orthopaedic Surgery, Professor of Pediatrics

Department of Orthopaedic Surgery

University Hospital

Iowa City, Iowa

Disclosures: Weinstein reports he is the principal investigator of the BrAIST study.