Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions
USPSTF: Screening for Adolescent Idiopathic Scoliosis
JAMA; 2018 Jan 9; USPSTF, et al
The US Preventive Services Task Force (USPSTF) has issued a recommendation statement on screening for adolescent idiopathic scoliosis after reviewing the evidence on both its benefits and harms. The statement updates the 2004 USPSTF recommendation and includes the following findings and conclusions:
- The USPSTF found inadequate evidence on treatment and exercise and surgery.
- There was adequate evidence that treatment with bracing may slow curvature progression in adolescents with mild or moderate curvature severity; however, the evidence in long-term outcomes in adulthood is inadequate.
- The USPSTF found inadequate evidence on the harms of treatment.
- Therefore, the USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for adolescent idiopathic scoliosis in children and adolescents aged 10 to 18 years.
Citation:
Screening for adolescent idiopathic scoliosis. US Preventive Services Task Force recommendation statement. JAMA. 2018;319(2):165–172. doi:10.1001/jama.2017.19342.
Adolescent idiopathic scoliosis begins in early adolescence and can progress during skeletal maturation in a small percentage of individuals to a degree of scoliosis that can be disfiguring, cause back pain, and lead to cardiopulmonary problems when severe. It has a prevalence of 1-3%, and is defined as the angle measured on x-ray, the Cobb angle, >10%. Screening is recommended by the American Academy of Pediatrics and the American Academy of Orthopedic Surgeons. Those groups recommend screening girls at 10 and 12 years and once in males at 13 or 14 years. Screening is also required by many schools. Inspection for scoliosis is usually done by visual inspection of the spine both with patient standing and then bending forward, a maneuver called the forward bend test, during which the clinician looks for asymmetry of the shoulders, shoulder blades, and hips. A scoliometer may be used to measure the angle of rotation, or more commonly clinicians may estimate the angle. An angle on the scoliometer > 5-7%, or on visual inspection > 5-10%, is often used to trigger ordering a spine series x-ray to more precisely measure the Cobb angle. On x-ray, the Risser sign is also measured which shows the stage of ossification of the iliac apophysis, indicating degree of skeletal maturity, with more mature spines less likely to have progression of scoliosis. Typically patients with a Cobb angle < 20° are observed with serial x-rays. Patients with a Cobb angle > 30° or a Cobb angle of 20° to 30° that progresses ≥5° over 3 to 6 months are usually treated with bracing. — Neil Skolnik, MD