School screening for scoliosis

Positive effects of prescriptive screening include increased awareness of the condition of adolescent idiopathic scoliosis in the public and health care profession. Unfortunately, screening started without a validated screening test and generated far too many false positives. We also know that adolescent idiopathic scoliosis is not a health care problem on a public health scale, nor is screening for it cost-effective. Like many other screening programs, it is seen as health care and is going to be difficult to eliminate. However, children who do not have ready access to primary medical care may benefit from screening. Meanwhile, boys are clearly an inappropriate subset. The rationale for screening to be continued is only for epidemiologic reasons, to learn more about how the deformity develops and to increase our knowledge about natural history. In turn, we might be able to devise nonoperative methods that will clearly alter natural history favorably. We feel that it is not an overstatement to repeat the cautions about proceeding without a validated test. If we had a validated screening test we would be in a far more powerful position to measure screening and more likely to generate both scientific and financial support. Meanwhile, the infantile progressive case, which really can be associated with serious cardiopulmonary compromise, must not be overlooked. Relevant knowledge about scoliosis should be an integral part of overall medical education.