USPSTF Draft Recommendation

Evidence Lacking to Support Screening Kids, Teens for Scoliosis

June 01, 2017 01:55 pm News Staff

On May 30, the U.S. Preventive Services Task Force (USPSTF) posted a draft recommendation statement(www.uspreventiveservicestaskforce.org) and draft evidence review(www.uspreventiveservicestaskforce.org) on screening for adolescent idiopathic scoliosis in children and adolescents ages 10-18 who are asymptomatic for the condition.

[Mom helping child with exercises in playroom]

The USPSTF concluded there was insufficient evidence to assess the balance of benefits and harms of screening for adolescent idiopathic scoliosis in this group -- an "I" recommendation.(www.uspreventiveservicestaskforce.org)

Adolescent idiopathic scoliosis is the most common form of scoliosis, affecting about 1 percent to 3 percent of U.S. children and teens in this age range.

Screening is usually done by visual inspection of the spine to look for asymmetry of the shoulders, scapulae and hips.

The forward-bend screening test is most commonly used in the United States. Patients are instructed to bend forward so that the spine is parallel with the floor, making it easier to perceive any unevenness. Physicians may also use a scoliometer to measure the angle of trunk rotation during the forward-bend test. A trunk rotation angle of 5 degrees to 7 degrees often is the threshold for referral to radiography.

Story highlights
  • On May 30, the U.S. Preventive Services Task Force (USPSTF) posted a draft recommendation statement and draft evidence review on screening for adolescent idiopathic scoliosis in children and adolescents who are asymptomatic for the condition.
  • The USPSTF concluded there was insufficient evidence to assess the balance of benefits and harms of screening for adolescent idiopathic scoliosis in this group.
  • This draft recommendation updates the USPSTF's 2004 stance, which recommended against screening for adolescent idiopathic scoliosis in children and adolescents with no signs or symptoms.

Screening may also be conducted using a humpometer, the plumb line test and Moiré topography (creating a three-dimensional image of the surface of a patient’s back).

If idiopathic scoliosis is suspected, radiography is used to confirm the diagnosis and to quantify the degree of curvature (i.e., the Cobb angle) and the Risser sign (the stage of ossification of the iliac apophysis).

"The major gap in knowledge is whether screening and early treatment of teens without symptoms leads to benefits that last into their adulthood," said USPSTF member Alex Kemper, M.D., M.P.H., M.S., in a news bulletin.(www.uspreventiveservicestaskforce.org)

This draft recommendation updates the USPSTF's 2004 final recommendation(www.uspreventiveservicestaskforce.org) against screening for adolescent idiopathic scoliosis in children and adolescents with no signs or symptoms -- a "D" recommendation.

The AAFP also released a final recommendation statement in 2004 against screening for scoliosis in asymptomatic adolescents.

"This 'I' statement is a call for more research to address the uncertainty in evidence about screening," said John Epling Jr., M.D., M.S.Ed., in the bulletin. "In the meantime, primary care clinicians should use their clinical judgment when deciding which patients to screen."

Update of 2004 Recommendation

In 2004, the USPSTF found fair evidence that treating adolescent idiopathic scoliosis led to health benefits (i.e., decreased pain and disability) in only a small proportion of patients. The task force also identified moderate harms of treating screen-detected adolescent idiopathic scoliosis at that time, including unnecessary brace wear and unnecessary referral to specialty care. Given these findings, the USPSTF concluded the harms of screening exceeded the potential benefits.

To update its 2004 recommendation, the USPSTF commissioned a new systematic review of the evidence, which found adequate evidence that treatment with bracing may decrease progression in adolescents with mild or moderate curvature severity.

However, no direct evidence was found that connected screening with health outcomes (i.e., data demonstrating an association between the magnitude of spinal curvature at skeletal maturity and adult health outcomes are lacking), and limited evidence was available on the harms of screening and treatment. The task force also found inadequate evidence on treatment with exercise and surgery.

Because the evidence supporting screening has evolved, the USPSTF said current evidence "reflects a decrease in the certainty of net benefit (from fair to low), leading it to issue an 'I' statement."

Up Next

The USPSTF is inviting comments on its draft recommendation statement(www.uspreventiveservicestaskforce.org) and draft evidence review.(www.uspreventiveservicestaskforce.org)

The public comment window is open until 8 p.m. EDT on June 26. All comments received will be considered as the task force prepares its final recommendation.

The AAFP will review the USPSTF's draft recommendation statement and supporting evidence and provide comments to the task force. The Academy will release its own recommendation on the topic after the task force finalizes its guidance.

Related AAFP News Coverage
Choosing Wisely
AAFP Releases Third List of Tests, Procedures Patients, Physicians Should Question

(9/24/2013)

More From AAFP
American Family Physician: Adolescent Idiopathic Scoliosis: Diagnosis and Management
(2/1/2014)

American Family Physician: Adolescent Idiopathic Scoliosis: Radiologic Decision-Making
(5/1/2002)

Familydoctor.org: Scoliosis(familydoctor.org)