Early Detection of Scoliosis-What the USPSTF “I” Means for Us.
Richard Hostin M.D.
Hresko, M. T., R. M. Schwend and R. A. Hostin (2018). “Early Detection of Scoliosis-What the USPSTF “I” Means for Us.” JAMA Pediatr. Jan 9. [Epub ahead of print].
In the current issue of JAMA is the latest recommendation statement by the US Preventive Services Task Force (USPSTF), and accompanying evidence report, on the value of screening asymptomatic adolescents for adolescent idiopathic scoliosis. Since the topic was last reviewed in 2004, important new evidence has emerged that potentially supports scoliosis screening. In this update, the USPSTF changed its grade of the evidence from a “D” (discourage the use of screening programs) to an “I” (uncertainty about the balance of benefits and harms of the service).1 The recommendation highlights the high sensitivity, specificity, and predictive value and the low false-positive rate of screening programs when the Adams forward bend test is paired with scoliometer measurements and Moiré topography. It is important to recognize that a properly implemented screening program will identify potential patients who can benefit from brace treatment, possibly avoiding surgery. In addition, spinal deformity may be the presenting sign of a variety of conditions, including heritable collagen disease, neurological conditions, or skeletal dysplasia unrecognized until adolescence. Even if surgery cannot be averted, early diagnosis of progressive curves allows for surgical intervention at the most opportune time. [Excerpt from text of this commentary; no abstract available.]