Discussing scoliosis screening in young people

With some recent media suggestions that scoliosis screening in Australian schools be resumed, a balanced discussion is required.

Firstly, a scoliosis is an alteration in spinal alignment, with increased curvature of the spine. Scoliosis is commonly noted when the curvature is a lateral/ sideways curvature (>10 degrees curvature for a diagnosis of scoliosis to be made), but scoliosis can also include rotational/ twisting malalignment of the vertebral bodies of the spine. Scoliosis is most common in the thoracic spine/ chest and lumbar spine/ lower back, and may also involve both of these spinal regions (i.e. a thoracolumbar scoliosis). Scoliosis generally causes spinal deformity, or chest wall deformity.

Idiopathic, or spontaneous, scoliosis is of unknown cause and is common in adolescents, affecting 1-3% of the population. Despite the unknown cause, approximately 25% of those with scoliosis also have someone else in the family with scoliosis, suggesting a partial genetic component. Idiopathic scoliosis is the main target of scoliosis screening programs. Other causes of scoliosis include: neuromuscular/ nerve and muscle disorders, congenital/ developmental disorders, including as part of a defined syndrome.

Idiopathic, or spontaneous, scoliosis is often detected incidentally with the abnormal spinal alignment being seen on imaging for another medical issue (e.g. having a chest Xray for breathing issues, or pneumonia, and detecting the scoliosis), or noted in young people wearing open backed clothing where the thoracolumbar spine is visible.

It is because idiopathic scoliosis is common, and has relatively few apparent symptoms, that scoliosis screening in young populations has been suggested in the past, and currently. This may include school screening programs.

The difficulty with this approach is that scoliosis screening involves spinal Xrays, with accompanying radiation. Radiation dosing should always be minimised, but especially in children and adolescents due to the developing body organs and tissues, and the length of time after radiation exposure (e.g. more years of life after the exposure).

Whilst some young people will benefit from the detection of idiopathic scoliosis via screening, the vast majority of those screened will have unnecessary radiation exposure from Xrays, for no individual benefit. Many of these young people with significant scoliosis may also be diagnosed through regular, or incidental, health care visits. Hence, the cost effectiveness of Xray screening programs for idiopathic scoliosis has always been controversial. As significant idiopathic scoliosis will generally cause obvious spinal or chest wall deformities, education around regular visual inspection of the alignment and symmetry of the growing spine and chest is perhaps a better approach. Detected abnormalities should prompt medical assessment and consideration of further investigations, including Xrays, as required.

The treatment of idiopathic scoliosis in young people is also complex and may involve bracing, exercise, or consideration of surgical correction. For more information, including scoliosis management, see the "Idiopathic Scoliosis" section in the FixitDoc app.