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May 31, 2008

Screening for IdiopathicScoliosis in Adolescents-AAP, AAOS, SRS, POSNA

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Screening for Idiopathic Scoliosis in Adolescents
The American Academy of Orthopaedic Surgeons (AAOS), the Scoliosis Research Society (SRS), the Pediatric Orthopaedic Society of North America (POSNA), and the American Academy of Pediatrics (AAP) convened a task force to examine issues related to scoliosis screening and to put forth the present information statement.

Scoliosis Screening in 2007-Summary
Although the AAOS, SRS, POSNA, and AAP recognize that support for scoliosis screening has limitations, the potential benefits that patients with idiopathic scoliosis receive from early treatment of their deformities can be substantial. Scoliosis screening, whether in the physician’s office, nurses’ clinics, or school environment, provides the opportunity to diagnose the condition and make referral for appropriate medical care. Brace treatment in children with significant scoliosis may avoid the need for surgical intervention. Those with deformities in need of surgery may be identified by screening at a time when operative intervention can be performed most effectively. Many of these patients may otherwise go undetected, particularly in patient populations underserved by medicine. Females achieve adolescence about two years before males and are afflicted with a magnitude of scoliosis, requiring treatment three to four times more frequently than males. As a result, if scoliosis screening is undertaken, the AAOS, SRS, POSNA, and AAP agree that females should be screened twice, at age 10 and 12 (grades 5 and 7), and boys once, at age 13 or 14 (grades 8 or 9). The AAOS, SRS, POSNA, and AAP 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 or true scoliosis, though 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 objectives of scoliosis screening programs, the AAOS, SRS, POSNA, and AAP recognize the need to limit the number of referrals of those individuals suspected of having scoliosis. The AAOS, SRS, POSNA, and AAP maintain their commitment to avoid the inappropriate use of spine radiographs. Not all children referred as a result of screening require radiographs. If radiographs are needed, physicians should take necessary precautions to limit the patient’s exposure to radiation.

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