Adolescent Idiopathic Scoliosis: Diagnosis [Clinical Review]

Adolescent idiopathic scoliosis (AIS) is an exclusion diagnosis. Approximately 20% of scoliosis patients have an identifiable cause such as hemi-vertebrae, but 80% remain without known cause. Only after all causes can be ruled out can the diagnosis of AIS be appropriately made.

There is significant controversy relating to school screening programs used to identify students with scoliosis. Concern has been voiced that the programs are costly and refer far too many children for follow-up and possible treatment. The argument is made that AIS is a relatively rare condition, early detection does not alter the natural history and radiographic examination to monitor for progression of the curve poses a health risk to young girls. The United States Preventive Services Task force stated ”there is insufficient evidence for or against routine screening of asymptomatic adolescents for idiopathic scoliosis” (1). Others suggest the referral criteria should be tightened in order to refer fewer children (2). Still others argue that early intervention can be of benefit and screening is justified (3). An example of one school system’s screening program, which required 448 students be screened for each student treated, follows (4):

Children in screening program:  2242

Referred to physician:  92

Received scoliosis diagnosis:  27

Curves greater than 20°:  16

Number treated:  5

Surgical treatment:  2