Scoliosis: Screening and Effects
Scoliosis screening remains a controversial topic among health care professionals. In 1993 the US task force concluded that the potential harms of routine scoliosis screening did not outweigh the benefits. Another study in 2000 performed on the Rochester school districts of Minnesota calculated an average cost of $24.66 per student to perform scoliosis screens. Cost and false positive referrals have been a large reason why screening programs have been diminished or abolished.

However, the need for appropriate screening and follow-up has not diminished. Approximately 4.5% of the population has scoliosis, nearly 1 in 20 reading this article. The effects of scoliosis go far beyond the potential cosmetic concerns imposed. Some of these include; decreased pulmonary function, headaches, chronic neck and back pain, reduced exercise capacity, digestive problems, psychological distress, reduced quality of life, and shortened life span, and others.

What is Scoliosis?
Scoliosis is an abnormal curvature of the spine that looks like more of an "S", or "C", rather than a straight line. In approximately 80% of scoliosis cases the cause is unknown. A common class of scoliosis is adolescent idiopathic scoliosis, (AIS) in which the scoliosis develops at puberty with an unknown cause.
The word "scoliosis" typically brings to mind an image of someone wearing a gaudy brace when they were in high school. This is sadly unfortunate, and often unnecessary. Scoliosis also commonly progresses throughout adulthood, the rate is largely dependent on when the scoliosis started to develop and the size of the curve. In the past, many health care professionals viewed scoliosis that was caused from bad posture, muscle spasm, pain, etc. as non progressive and thus of little concern. We know now, this is untrue, in fact, even these types of scoliosis can and do progress.

Current Treatment Procedures:
Current literature states that screening measures do not reduce the need for surgery. Ref(Early Weaning). Considering traditional portal of entry health care prescribing all or any of the following; observation, bracing, surgery, this is not all that surprising. If a child’s scoliosis is fortunate enough to be detected, here is a typical scenario. Children will be "observed" until the curve reaches approximately 25 degrees. Should it reach 25 degrees, and it commonly does, a hard brace is prescribed to halt progression. From 25-45/50 degrees the recommendation of hard bracing continues. Beyond 45-50, surgery is typically considered and in many cases the recommended treatment strategy .

Let’s summarize this, first we did nothing, (observation), then we used a hard brace, (psychological impairment) which if successful only halts the curve’s progression, and if not, it’s potentially a life altering surgery (high risk and permanent). Bracing is largely debatable with regards to effectiveness. This is due to compliance since the recommended wear time is approximately 20-23 hrs/ day. There is also research to illustrate that the curve slowly starts to "bend" back to a pre bracing level throughout adulthood. Generally, the results of surgery aren’t any more promising. Unfortunately, if following traditional procedures, your child has an increased likelihood of receiving the same outcome, screened or unscreened.

How Are We Changing This?
Efforts of the medical community are greatly appreciated, recognized, and put forth with great effort. However, are in great demand of critical re-thinking. There is a demand for further education and implementation of more effective screening and treatment measures. Who is doing this? A growing number of conservative health care professionals are challenging the "norm" on issues such as these and reaching out to help many.

Conservative health care professionals until recently have largely been unsuccessful at treating scoliosis. However, innovation, research, and an ability to think outside the box have tilted the scales out of stagnancy to reach out and help many individuals with scoliosis. Conservative treatment is finding positive results through a thorough understanding of the inherent structural and neurological adaptations associated with scoliosis. Another is the emphasis on early detection, since we are commonly seeing both children and adults with greater health concerns as a result of failed, or lack of treatment prescribed previously. Cost has a large role in the reason not to screen as well as false positive referrals. Cost will always be a concern if there is not a cost effective result. These conservative measures aren’t a "cure", or "quick-fix", by any means. They require a commitment on behalf of the patient. However, we are seeing more rewarding results with fewer side effects. Not to mention empowering patient’s, families, and others with through education. Sound exciting, it is, now some education on basic scoliosis screening.

Basic Screening Measures:
There are some general factors to be aware of when "sizing up scoliosis". One factor is knowledge of your family history. Scoliosis is largely a multifactorial condition, however certain characteristics seem to be inheritable making some individuals more susceptible due to their family history. Families where scoliosis is present should be ever so diligent in routinely checking their children. A routine screening measure typically used is the Adam’s forward bend test. This involves having the child bend in front of the observer while any rib humping is noted. This is the primary screening method used in a school system if they should have a screen. Something is better than nothing, however if noticeable rib humping is present, the child’s scoliosis is already at a higher magnitude.

The next is the child’s posture. Scoliosis often causes the waistline or shoulders to appear uneven. Their posture should be analyzed while they are in a relaxed state, since many of them have gotten to be quite good at mimicking a more normal posture. Clothing may also be uneven due to these asymmetries. Individuals with scoliosis may often exhibit a "librarian’s posture", in that they look out the top of their eyes. The condition, called hyperopia, alters the visual field and thus causes neuromuscular adaptation from the skull down. Hyperopia, effecting the visual system is just one of the body’s natural righting reflexes.

The body has five major righting reflexes that enable us to coordinate movement, perform tasks, stand upright and many others all with relation to gravity. Scoliosis is typically associated with deficient righting reflexes. There are some simple and relatively inexpensive ways to test the body’s natural "righting reflexes". An example of impairment of one of the righting reflexes is illustrated by loss of balance. Therefore, have the child stand on one leg with his/her eyes open and closed for 30 seconds. Individuals with scoliosis will often have difficulty standing on one leg with their eyes closed and commonly fail this test before 30 seconds.

Another simple test is to observe them try and touch their chin to their chest. The inability to touch their chest with their chin this also may be indicative of scoliosis. Remember that scoliosis not only effects the spine/posture, but other systems as well. Relying exclusively on one test, such as the traditional forward bend test excludes other signs/symptoms that may be apparent with other tests. Therefore incorporating additional tests such as these will help you be more accurate, miss less cases, and increase the chances of early detection. Lastly, you should know that pain does not always accompany scoliosis, so using this as an indicator is not recommended.

There are many other instruments that a health care professional specializing in scoliosis may use if you are suspicious after performing some of these tests. They might include a scoliometer which measures trunk rotation, advanced neurological testing, gait analysis, x-ray, and others. With early detection, as with any disease process the outcome is generally much more favorable.

References:
U.S. Preventative Services Task Force. Guide to Clinical Preventive Services. 2 nd ed. Washington, DC: Office of Disease Prevention and Health Promotion; 1996.