At what age is screening for scoliosis recommended?

Scoliosis Screening Recommendations

Scoliosis screening should be performed for females twice at ages 10 and 12 years, and for males once at age 13 or 14 years, as recommended by major orthopedic and pediatric organizations. 1

Screening Rationale and Approach

Scoliosis is defined as a lateral curvature of the spine greater than 10 degrees on radiography, typically associated with trunk rotation. The prevalence of adolescent idiopathic scoliosis (AIS) is approximately 2-4% in children aged 10-16 years 1, 2.

Screening Protocol:

• Target population:

  • Girls: Screen at ages 10 and 12 years
  • Boys: Screen once at age 13 or 14 years

• Screening method:

  • Forward bend test with scoliometer measurement
  • Referral threshold: Angle of trunk rotation (ATR) ≥10° 3
  • Additional screening tools: moiré topography and clinical signs assessment improve sensitivity 3

Referral Criteria

Patients should be referred to a pediatric orthopedic surgeon when:

• Curves greater than 10 degrees in children under 10 years of age
• Curves greater than 20 degrees in children 10 years or older
• Any curve associated with pain or neurological abnormalities 4

Evidence Strength and Controversies

The recommendations for scoliosis screening have evolved over time. In 2008, the American Academy of Orthopaedic Surgeons, Scoliosis Research Society, Pediatric Orthopaedic Society of North America, and American Academy of Pediatrics issued a joint statement supporting the potential benefits of early treatment for patients identified through screening 1.

However, it's important to note that the U.S. Preventive Services Task Force and the American Academy of Family Physicians have found insufficient evidence to assess the balance of benefits and harms of screening for adolescent idiopathic scoliosis in children and adolescents 10-18 years of age 2.

Common Pitfalls to Avoid

1. Delayed referral: Failing to refer patients with significant curves or progression can lead to missed treatment opportunities

2. Inadequate monitoring: Children with mild curves still require regular follow-up to detect progression

3. Overlooking non-idiopathic causes: Consider conditions like Marfan syndrome, Ehlers-Danlos syndrome, and neurofibromatosis type 1 that are associated with scoliosis 4

4. Neglecting psychological impact: Scoliosis can affect body image and psychological well-being, especially in adolescents

5. Selective screening only for girls: While scoliosis is more common in females (with a 10:1 ratio for developing larger curves), males should still be screened as recommended 4, 3

Clinical Significance

Early detection through appropriate screening allows for:

• Timely intervention with bracing for moderate curves (20-50°) in skeletally immature patients
• Prevention of curve progression
• Potential avoidance of surgical intervention
• Monitoring for associated complications in severe cases

While mild scoliosis is usually asymptomatic, severe scoliosis (Cobb angle ≥40°) may cause physical pain, cosmetic deformity, psychosocial distress, and rarely, pulmonary disorders 2.