Brace, Brace, Brace!
“Bracing in adolescent idiopathic scoliosis (AIS) decreases the risk of curve progression and need for surgery, but optimal brace treatment requires early curve detection.”
Scoliosis: An abnormal curvature of the spine, creating an S/C shape.
Scoliosis is a condition affecting 2–3% of the population worldwide1 and can impact the quality of life of those affected by limiting daily activities, causing chronic pain, reducing respiratory function and diminishing self-esteem.
AIS can develop at any age but is most common in children aged 10–15 years with 3 or 4 out of every 1,000 children needing treatment for this condition.2 In general, AIS curves progress during the rapid growth period of the patient and, according to the Scoliosis Clinic UK, scoliosis affects girls more than boys: it's frequently noted that about 75% of adolescent idiopathic scoliosis patients are female.3
The severity of scoliosis is defined using a Cobb angle which measures the curvature of the spine.4 A Cobb angle of >40° indicates severe scoliosis where non-surgical care is often less effective and the likelihood of requiring surgery is much greater.4,5
In 2006, a study from the University Colleague Hospital and The London Clinic reviewed 100 people with AIS documented from detection to treatment.6 They found that 63% of cases were detected by friends or family, with 70% of these having a Cobb angle of more than 40°.6 The same study reviewed the incidence and detection of scoliosis since 1985 and found that cases detected at school had dropped considerably to only 8% compared to 32% in 1985 when a school screening programme was in place.6
In the UK, the National Screening Committee (NSC) does not recommend screening for AIS in adolescents. A 2015 review by the NSC concluded that this was because “there is not enough evidence to show if detecting the condition earlier through screening results in better health outcomes than waiting until symptoms develop.”7 The review claimed a high false positive rate and a low positive predictive value for the screening test (the Forward Bend Test) as key reasons behind this decision as well as uncertainty around an optimum screening approach in terms of the optimal age and threshold for referral and a lack of evidence that early treatment, as a result of screening, would improve outcomes compared with treatment following clinical detection.7 Later reviews by the NCS have not changed this opinion.7
I, myself was diagnosed late at 20 years old with a Cobb angle of 32°. Within 2 years of my diagnosis my curve had progressed to 45° with surgery being my only offered treatment. With hindsight, there were a number of signs before my diagnosis that should have rung alarm bells for me and caused me to get myself checked out much earlier. I believe that had a scoliosis check been offered to me at school, we would have been able to at least try to stop the progression of my spinal curve with a brace and potentially avoided surgery entirely.
I wholeheartedly believe that greater awareness is needed in the wider community to help friends, families, teachers and GPs detect AIS earlier and potentially prevent unnecessary surgery.
So, I leave you with a question: Do you think it’s time for school checks to become a common occurrence again in the UK?
References:
- American Association of Neurological Surgeons. Scoliosis. Available at: https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Scoliosis (Accessed June 2024).
- Livi. Scoliosis. Available at: https://www.livi.co.uk/medical-advice/musculoskeletal/scoliosis/ (Accessed June 2024).
- UK scoliosis clinic. Scoliosis gender. Available at: https://scoliosisclinic.co.uk/tag/scoliosis-gender/ (Accessed June 2024).
- Horng MH, et al. Comput Math Methods Med. 2019;2019:6357171.
- Anthony A, et al. Spine Deform. 2021:9(1):75–84.
- Fazal M and Edgar M, Acta Orthop. 2006;72:184–186.
- Gov.uk National Screening Committee: Scoliosis. Available at: https://view-health-screening-recommendations.service.gov.uk/scoliosis/ (Accessed June 2024).