Prescriptive screening for adolescent idiopathic scoliosis: a review of the evidence.

Published data relating to prevalence, natural history, treatment and prevention adolescent idiopathic scoliosis (AIS) are examined. Screening programmes could lead to about 10% of 11-15 year old schoolchildren being referred for diagnosis, involving, for many, an X-ray of the spine. About 1 in 5 of the children referred would be diagnosed as having AIS; of these 1 in 10 would have treatment, either by the wearing of a brace, or in more severe cases by operation and fusion of the vertebrae. The data suggest that in most cases of AIS the spinal curve regresses or at least does not progress. Treatment, whether by brace or operation, is onerous and not always successful. Very little is known for certain about the causation of AIS and the interplay of various factors in its development and regression. The case for widespread adoption of prescriptive screening programmes is not yet established. There is an urgent need to coordinate and increase research designed to determine the aetiology, incidence, prevalence and course of AIS; to find factors that distinguish a rarer progressive form, commoner in girls than boys, from a more frequent and apparently benign form; to develop reliable and valid screening techniques; and to evaluate different forms of treatment. Some of these studies will have to be carried out by collaboration between a number of centres. Current screening programmes should be rigorously evaluated, all children who are referred for diagnosis and treatment should be examined in designated centres and the findings and details of treatment should be recorded systematically, using agreed definitions and criteria that will ensure that the experience of collaborating centres can be collated.