Scoliosis - Diagnosis

One way of predicting whether or not the curvature will progress is knowing when the child will stop growing:

If the child has years to grow, then the spine has more time to progress.
If the child will stop growing within a year, then progression should be very slight. (It should be noted, however, that some progression continues in nearly 70% of curves even after the spine has matured.)
Knowing the child's age is, of course, the first step in estimating the end of growth. In addition, other methods have been developed to help predict the end of the growth stage.

One method is called the Risser sign, which grades the amount of bone in the area at the top of the hipbone. A low grade indicates that the skeleton still has considerable growth; a high grade means that the child has nearly stopped growing and the curve is unlikely to progress much further. The Risser scale differs between genders, and in boys, a high grade does not always signify the end of progression.

To Screen or Not to Screen for Scoliosis

Screening programs for scoliosis, which began in the 1940s, are now mandatory in middle or high schools in many states, but there is considerable debate over whether screening should be routine.

Arguments Against Routine Screening

US Preventive Services Task Force does not recommend routine screening to detect adolescent scoliosis for the following reasons:

Screening tests are not accurate and depend too much on the skill of the examiner.
Schools often refer children with minor curves who are not at any risk for a progressive or serious condition to physicians, and such over-referrals add considerably to the costs of the health system. In one major 1999 study, 94% of the children referred to a physician by the school did not require treatment. (Over 2,000 children were screened in order to find only five children who did need treatment.)
A long-term study of untreated patients with late-onset scoliosis indicates that these patients are productive and functional at a high level at 50-year follow-up. Patients with scoliosis have no greater danger for significant lung problems than the general population until their curves reach 60 to 100 degrees, making early screening unnecessary.
At the time of the Task Force, studies were also showing no benefits from the early treatments, specifically braces.

Experts against screening argue, then, that such programs result in early treatments that either will not prevent curve progression and surgery or are unnecessary in the first place since curvatures often do not progress at all.

Arguments for Routine Screening

The American Academy of Orthopaedic Surgeons recommends that girls be screened twice, at ages 10 and 12, and that boys be screened once at 13 or 14. The American Academy of Pediatrics recommends, however, scoliosis screening at ages 10, 12, 14, and 16 years. (In one study, over 40% of high school sophomores with newly diagnosed scoliosis had shown no signs of the disorder in earlier screening tests.) Other experts make the following arguments for universal screening:

Universal screening is useful for producing information on scoliosis that may eventually lead to knowledge of its cause and ways to prevent it.
Braces have been proven to be effective since the task force's recommendation and early treatment can be important.
Without screening, the chances are slim that children with scoliosis will be diagnosed at an early stage if they can only rely on examinations by a family physician or pediatrician. Such physicians often do not even look at backs and, if they do, they tend to use only the forward bend test, which is not accurate.

In any case, some experts argue that widespread screening would be cost effective if schools had reasonable guidelines to use for determining which children should see a physician for further testing. The following are some suggested guidelines for determining the need for a physician referral:

Children should be sent to a physician only if they have a 30-degree curve. (A 20-degree curve with a 5-degree trunk rotation has been the criteria for recommending treatment, although up to 80% of 20-degree curves do not get worse.)
Children with curves between 20 and 30 degrees would be screened every six months.

Such guidelines would detect about 95% of all genuinely serious cases while referring only 3% of all children tested, thereby cutting costs without jeopardizing children.