Natural history and school screening for scoliosis.

In light of the questions and controversy regarding school screening for spinal deformities, should the programs be dropped? The natural history is not completely known and the results of nonoperative treatment questioned. The costs are high due to over-referral and numerous physician visits and radiographs. Would it not be best to wait until the epidemiologic questions are answered? The best approach is one in the middle ground. The program needs to be organized and strengthened. With the education of screeners, over-referral can be reduced. The treating physician must confirm the physical finding, take appropriate radiographs, and plan appropriate follow-up. In this way, the costs will be reduced. In addition, with knowledge regarding natural history, only larger curves or progressive curves will be treated. Nonoperative treatment of idiopathic scoliosis is effective. It can control progression and even result in correction of some curves. The overall effectiveness of braces and electrical stimulation needs to be constantly reviewed. How do these forms of nonoperative treatment affect the progressive curve, and do they reduce the need for surgery in idiopathic scoliosis? Only after we have more studies on natural history and on the results of nonoperative treatment can screening for scoliosis be reassessed to determine its role in the overall treatment program of spinal deformities.