Importance of school spinal screening in early diagnosis of spine deformities

Abstract

Introduction: Spine deformities, especially idiopathic adolescent scoliosis is a common disease with a prevalence of 0.47– 5.2 %. Early clinical detection of scoliosis relies on careful examination of trunk shape and is subject to screening programs in many countries. School-based screening for scoliosis is performed primarily for the purpose of early detection of spinal deformity, which enables implementation of early conservative treatment that can reduce the risk of curve progression. Although X-ray is the gold standard for diagnosis of idiopathic scoliosis, it is not used as a screening method because of the risks associated with radiation exposure. Materials and methods: School spinal screening was performed in Republic of Moldova for the first time. A project initiated by the authors has been started in the schools of Chisinau city. School spinal screening was performed in 2741 pupils aged 6-17, mean age - 11,47±0,057 (95% CI: 11,36-11,58). There were 1278 (46,63%) girls and 1463 (53,37%) boys. Clinical orthopedic examination of the spine was performed using six standard positions including Adams forward bending test and the scoliometry - measurement of angle of trunk rotation (ATR). Seven degrees of ATR was chosen as cut-off point for referral to radiography. Results: During school spinal screening we detected 773 children with spine deformities, the majority was determined for the first time. Functional spine deformities were found in 641 pupils presenting as round back (15,9%), flat back (18,3%), lordotic (4,8%), kypholordotic (11,9%) and asymmetric (49,1%) posture. Scoliosis gr.I-II was detected in 132 pupils who presented positive on both standing, forward bending test and scoliometry > 7’. There were 82 (62,1%) girls and 50 (37,9%) boys. Definitive diagnosis was confirmed on standing spondilography. The individual treatment program was created for everyone. Conclusions: The proposed complex examination scheme including orthopedic clinical and instrumental examination, provides to determine the risk factors of development of spinal deformity, monitoring ensures the accuracy of diagnosis, prediction of the disease and helps to improve clinical and functional outcomes of rehabilitation.