Screening and methodological studies on Adolescent Idiopathic Scoliosis

Adolescent idiopathic scoliosis (AIS) is a complex three dimensional deformity of the spine that affects 2-3 % of healthy adolescents. The cause is not known although genetic, hormonal, and environmental factors are involved. Idiopathic scoliosis in adolescents does normally not result in death, but affects health related quality of life. Brace treatment is recommended in growing adolescents with major curves >25° and surgery is recommended for curves >45° in immature adolescents. Treatment outcomes were in the past mainly evaluated by radiological measures. In recent years, outcome evaluation is increasingly being based on the patient’s perspective in addition to evaluations of care providers. The Scoliosis Research Society 22 questionnaire (SRS-22) is widely used to evaluate health related quality of life (HRQoL) in AIS patients. We have trans-culturally translated, validated, and adapted the SRS-22 questionnaire for use in Norwegian patients. The Norwegian version of SRS-22 questionnaire has acceptable validity and repeatability. Scoliosis progression is associated with rapid growth of the spine. Early detection by screening allows for curve monitoring and timely initiation of brace treatment leading to reduced rates of surgery that may save costs, but its effectiveness is debated. Screening was abolished in Norway in 1994 presumably for lack of efficacy and rising costs. In 2007-2008 we conducted screening on 4000, 12 year-old children. The study was originally designed to screen 12000 children, but was not supported by the Directorate of Health. The point prevalence of scoliosis was 0.55 %. We found acceptable sensitivity, specificity, and positive and negative predictive values. Screening performed once, was fast, simple and inexpensive, but did not detect any child suitable for bracing. During 2003-2011, 765 children were referred to our specialist clinic and their characteristics were evaluated. Close to 80 % were detected by non-health care providers. More than 45% were detected and referred too late for brace treatment. Compared to the period 1976-1988 when screening was still performed, fewer patients are currently treated with brace and more patients operated. The detection of scoliosis in the absence of screening in Norway is suboptimal; two years later than internationally recommended. The HRQoL of patients treated for scoliosis with brace and surgery has been reported to be equal in the long term. We performed a cost minimization analysis comparing relative costs in screening and non- screening settings. Costs are comparable to similar programs in Europe. Screening was cost saving when leading to high rates of bracing and low surgical rates. Cost saving was higher when girls only are selectively screened