School spinal screening in Moldova: first steps

Abstract

Introduction: Scoliosis presents a great problem for orthopedists in most countries. It is widespread in children and adolescents, and ranges from 1,3-3 to 27,6% of them. Surgical treatment is carried out too late, when the deformation of the spine becomes extremely severe. The risk of surgical intervention in such cases is too high. To solve this problem, many countries develop the scoliosis screening programs. Screening for scoliosis has been practiced worldwide for many years and has provided valuable knowledge about prevalence, aetiology and the natural history of idiopathic scoliosis. School screening for scoliosis beyond its scope of early identification of spine deformities has contributed to the field of research for aetiology of idiopathic scoliosis. Early diagnosis allows for bracing that is reported to be effective by numerous outcome studies. Unfortunately, we have not such a program in the Republic of Moldova. As a result, a lot of young patients come to our clinic with severe spine deformities which can be treated only by surgical intervention. Methods: A primary orthopedic examination was performed of 1398 pupils, aged from 7 to 18: 728 girls (52,07%) and 670 boys (47,93%). The screening procedure combined the visual inspection of the trunk in 6 positions, including the Adam Forward Bending Test and the scoliometer measurement of angle of trunk rotation (ATR). Seven degrees of ATR was chosen as cut-off point for referral to radiography. Results: Fifty seven (4,07%) pupils were found positive on both standing, forward bending test and scoliometer measurements > 7°. There were 41 (71,93%) girls and 16 (28,07%) boys. Fifty four (3,86%) were confirmed with spine deformity on standing radiographs, from which 39 (72,22%) girls and 15 (27,78%) boys. 2 girls and 1 boy had normal spine curvatures on X- ray examination (false positive). Individual treatment program are to be elaborated for the each patient. Conclusions: School spinal screening programs are used in many countries around the world for early diagnosis of spinal deformities, they establishing this pathology at the beginning when physical exercises and brace therapy are helpful; reduces the necessity of surgical treatment. In spite of intensive development of many instrumental methods for orthopedic examination the main method is the physical one with scoliometry. We have just begun this difficult work and hope to cover the entire young population of the Republic of Moldova.