The Problem with U.S. Screening Practices

by Eve Parrott

A back affliction that can prompt symptoms from unusual posture to severe back pain or difficulty breathing, the true danger of scoliosis, which affects 2-3% of the US population, lies in its ability to advance rapidly. Adolescent idiopathic scoliosis, which constitutes approximately 80% of all cases, is found in children ages 10-15 (during the period of puberty). This is also the time when children experience the most growth. Without correction, rapid growth can dramatically increase the severity of their spinal curvature. At the height of adolescent spurts, scoliosis can develop as rapidly as 1 degree of increased curvature per month. Indeed, for scoliotic girls, whose curves are 8 times more likely to worsen after diagnosis than boys’, the period right before menarche puts them in the greatest danger of experiencing severe curve growth.

Despite the risks, schools across the nation offer a surprising lack of support to vulnerable students. In a 2015 study, a task force of four combined medical associations agreed that scoliosis screening programs should be part of medical preventative services offered in schools and that they are effective in preventing curve progression. The US Preventive Services Task Force, however, disagreed, stating in 2018 that there was insufficient evidence to recommend screening programs.

​​Some states have taken matters into their own hands. Out of 50, 26 have implemented a lower-education screening program. These can range from annual tests through 3rd to 12th grade (New York) to scattered or isolated screening periods in 1, 2, or 3 grades. Of the 26, only 8 have a screening period that spans multiple consecutive years.

Inconsistent screening programs foster the potential for disastrous consequences. The average age of curve progression is 11.7 years. In 32 of 50 states, there are inadequate, unclear, or no screening practices in place to prompt preventative care at that age. Additionally, since the vast majority of screening programs begin at age 10 (grade 5) or older, these programs have a limited capacity to catch juvenile scoliosis. Juvenile scoliosis, which occurs between ages 3-10, constitutes a sizable 12-21% of all pediatric cases. Such a scenario presents significantly more dangerous possibilities for patients. Surgical options have a 40-55% risk of long-term complication, which may include damage to the subjects’ nerves, bleeding, or infection. Bracing, on the other hand, has a 73.2% success rate in preventing further curve progression and little effect on the patients’ daily activity or future health.

The failure and inconsistency of American screening programs reflects sad prospects for our youth’s health and wellness. In order to ensure the safety of millions of American children, the government must implement across-the-board screening mandates at a national level, spanning all grades from 5th to 10th at the very least. Failing that, families and students must be educated in the most common symptoms of scoliosis, in the hopes of developing a culture of early detection, scoliosis awareness, and acceptance.

Works Cited

AANS. “Scoliosis.” American Association of Neurological Surgeons, 30 Apr. 2024, www.aans.org/patients/conditions-treatments/scoliosis. Accessed 28 Aug. 2024.

Asher, Anne, et al. “School Scoliosis Screening Programs.” Verywell Health, 15 Sept. 2023, www.verywellhealth.com/school-scoliosis-screening-programs-296508.

Costa, Lorenzo, et al. “The Effectiveness of Different Concepts of Bracing in Adolescent Idiopathic Scoliosis (AIS): A Systematic Review and Meta-Analysis.” Journal of Clinical Medicine, vol. 10, no. 10, 15 May 2021, p. 2145, pubmed.ncbi.nlm.nih.gov/34063540/#:~:text=Brace%20treatment%20is%20the%20most, https://doi.org/10.3390/jcm10102145.

“Idiopathic Scoliosis.” Boston Children’s Hospital, www.childrenshospital.org/conditions/idiopathic-scoliosis.

“Scoliosis - Diagnosis and Treatment.” Mayo Clinic, 13 May 2023, www.mayoclinic.org/diseases-conditions/scoliosis/diagnosis-treatment/drc-20350721.

“Scoliosis Screening Map.” National Scoliosis Foundation, www.scoliosis.org/information/map/.

“Scoliosis Statistics.” CLEAR Scoliosis Institute, 2022, clear-institute.org/learning-about-scoliosis/scoliosis-statistics/.

Siddiqui, Aatif. “Scoliosis Surgery (Spinal Fusion): Risks vs. Benefits.” Treating Scoliosis, 13 Aug. 2024, treatingscoliosis.com/scoliosis-surgery/. Accessed 28 Aug. 2024.