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Scoliosis is an abnormal lateral curvature of the spine.
It occurs in approximately 2% of the U.S. population. School screening
for scoliosis is a process by which students in the age groups
considered to be at risk are examined by a school nurse for signs that
would suggest the presence of scoliosis. Screening for scoliosis had
been practiced in the United States for over thirty years. The value of
school screening, however, is still questioned by some. Those who argue
against school screening state that the yield rate is too low to justify
the cost. They also argue that the screening methods are too sensitive
and therefore result in the referral of too many children that do not
actually have scoliosis. Fewer than one out of every 400 children
screened for scoliosis actually require treatment.
On the other hand, the majority of spine specialists are
in favor of school screening for scoliosis. The following is the
position statement issued jointly by the American Academy of Orthopaedic
Surgeons and the Scoliosis Research Society: " The purpose of school
screening for scoliosis is to detect scoliosis at an early state when
deformity is mild and likely to otherwise go unnoticed. It is at this
early stage that bracing programs may be effective in halting the
progression of the deformity and thus prevent the need for surgical
treatment. In addition, the children with more significant scoliosis who
often have no other symptoms may be detected at a time when surgical
treatment is more effective."
It is now well proven that bracing is effective (approximately 70% of
the time) in preventing small curves from becoming large enough to
require surgery. Currently the best method of detecting these small
curves is through school screening. In recent years efforts have been
made to make the school screening process more selective for those
children with true spinal deformity and thus reduce the number of
children referred unnecessarily.
Since a single scoliosis operation may cost thousands of dollars in
total medical expenses, it would appear that current scoliosis screening
programs are cost effective. Even if these programs cannot be proven to
be cost effective in strictly epidemiological terms, isn't it worth it
if children are spared unnecessary surgery?
In conclusion, there are those who question the value of school
screening programs, yet there is no solid evidence that is should be
discontinued. Since it is now well proven that bracing can be effective
if curves are detected early, we should not abandon the most effective
means for such early detection.
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