School Screening for Scoliosis

By John J. Vaughan, MD

Scoliosis is an abnormal lateral curvature of the spine. As many as 2% to 3% of the population will have curves of 10º or more.

There are different types of scoliosis, including idiopathic, neuromuscular, congenital, and others. By far the most common type is idiopathic scoliosis; 90% of cases fall into this category.

Most cases of idiopathic scoliosis develop during the growth spurt that accompanies late childhood or early adolescence. Idiopathic scoliosis is frequently diagnosed and treated during these years. Generally, there are three different treatment plans for skeletally immature children or teenagers with scoliosis: observation, bracing, or surgery.

Prospective studies have shown that brace treatment can significantly lessen the progression of moderate curvatures (25º to 35º). The value of early detection of scoliosis, therefore, is that bracing, if initiated at the proper time, can prevent curve progression and avoid the need for surgical correction of the scoliosis.

In 1990, the Kentucky General Assembly passed House Joint Resolution No. 124. This resolution recognized scoliosis as a significant health concern and directed the Cabinet for Human Resources and the Department of Education to develop a policy for promoting appropriate and early diagnosis and treatment of scoliosis. These agencies, in conjunction with the Commission for Children With Special Health Care Needs, implemented these policies.

School screening for scoliosis is carried out in the sixth and eighth grades. All children entering the sixth grade must have a physical examination performed by a licensed health care provider (physician, physician's assistant, or nurse practitioner). During this examination, the health care professional completes a form that asks about the presence of spinal abnormalities.

In the eighth grade, most children undergo a scoliosis screening at the school they attend. This screening is usually performed by school nurses. In schools that do not have a nurse, screening is done by physical education teachers or trained volunteers. Techniques for scoliosis screening are demonstrated in Figures 1 and 2.


Normal                Scolisosis

 

STANDING POSITION

Observe for:

  • Shoulder or scapula imbalance
  • Pelvic obliquity
  • Trunk asymmetry
  • Cutaneous abnormalities (hairy patch at base or spine or café au lait spots)

FORWARD BEND

Observe for:

  • Rib or lumbar asymmetry or prominence

Figure 1. Screening techniques.

 

Figure 2. In scoliosis screening, chest wall asymmetry may be detected by visual observation or by the use of a scoliosis inclinometer (scoliometer). A measurement of 6° or 7° is usually considered significant and warrants a referral to a physician.

In Kentucky, the parents or legal guardians of children in the eighth grade must sign a permission form before scoliosis screening can be carried out. Students whose parents do not sign this form are not screened.

The implementation of these policies appears to be successful in regard to increasing the number of counties that perform scoliosis screening and increasing the number of children being screened (see Table 1). Also, there is now consistency among the districts in the timing of screening (sixth and eighth grades) in contrast to the years before 1991, when screening was carried out at any time during grades one through nine, depending on the school.

Table 1 Statewide Scoliosis Screening Statistics Commission for Children With Special Health Care Needs

School Year

# of Counties Reporting

Grades Screened

# Referred

# Referred

1983-1984
1984-1985
1985-1986
1986-1987
1987-1988
1988-1989
1989-1990
1990-1991
1991-1992
1992-1993
1993-1994
1994-1995
1995-1996
1996-1997

85
113
100
99
107
99
91
94
85
120
120
120
120
120

6-9

1-9, Depending on School
1-9, Depending on School
1-9, Depending on School
1-9, Depending on School
1-9, Depending on School

6-8
6-8
6-8
6-8
6-8
6-8

57,378
59,008
57,935
56,475
54,330
62,639
38,011
51,112
50,905
56,772
75,763
71,348
80,217
71,288

2,490
4,929
1,969*
2,161*
1,530*
2,090*
1,575*
,438*
2,282*
2,929
2,565
2,953
2,475
2,491

*Not all schools report this number.

Acknowledgment: Donna Hill, Commission for Children With Special Health Care Needs, Louisville; and Terry Vance, Kentucky Department of Education, Frankfort.

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Last Updated: 10/4/03