Scoliosis screening should start at a younger age

As the little boy's physical exam was winding down, I had him do a forward bend to try to touch his toes. This allowed me to note flexibility, check his spine, observe his foot placement, and perhaps most importantly, figure out if the young man could easily understand and follow directions.

One thing I did not expect to find in an 8-year-old boy was a spine that was anything other than straight. However, when I watched my patient bend over, using his spine as my midline, I noticed that the right half of the boy's back was not level with his left.

I reassured the mother that subtle curvatures of the spine generally do not affect back comfort or function. I did, however, want to be cautious with a boy this young since spinal curves can progress with age, so I sent him on for further orthopedic evaluation. My surgical colleague measured the patient at a very low degree of curvature, but did recommend periodic screening to observe for any progression, or worsening of the curve, as the boy grew.

Pediatric orthopedic sources record scoliosis in 3 percent of the population. Specialists do not consider a case of spinal curvature to be true scoliosis unless the degree of curvature is measured at 10 degrees or greater. Significantly higher curves of 40 degrees and above are classified as severe scoliosis. The cause of most spinal curvature is unknown and therefore labeled "idiopathic scoliosis."

A child's back is examined during routine medical exams, but some researchers feel that health and school professionals should be particularly alert for signs of scoliosis at three key stages. In a 2008 information statement endorsed by the American Academy of Orthopaedic Surgeons and the American Academy of Pediatrics, Drs. B. Stephens Richards and Michael Vitale suggest screening for scoliosis at ages 10 and 12 for girls, and at age 13 or 14 for boys.

The authors note that girls should be screened for evidence of scoliosis at a younger age since girls develop earlier than boys. In addition, two scoliosis screenings are recommended for girls because young females have three to four times as many cases of serious scoliosis requiring treatment than do their male counterparts.

Richards and Vitale explain that scoliosis screening can help identify moderate cases, which can benefit from a nonsurgical intervention known as bracing. This is important, as many orthopedic experts believe that bracing can decrease the risk of scoliosis progression in some younger patients by as much as 20 percent to 30 percent. Early scoliosis screening can also lead to timely identification of the more serious cases of scoliosis requiring surgery, increasing the likelihood of successful postoperative results.

Which pediatric patients are at risk for progression of their spinal curvature? In a comprehensive 2006 Pediatrics in Review article, Drs. David Stewart and David Skaggs report that risk is higher for youngsters with scoliosis who have much height growth ahead of them, as well as for those younger children who have already been diagnosed with curves above 20 degrees.

Parents occasionally ask if there are any legitimate scoliosis treatments outside of the standards of observation, bracing and surgery. To quote Drs. Stewart and Skaggs, "We are not aware of any scientifically valid evidence that physical therapy, manipulation, electrical stimulation, diet or other treatments correct scoliosis or reduce the risk of curve progression."

• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.