🩺 Scoliosis Screening [Neurosurgery Wiki]

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====== 🩺 Scoliosis Screening ======

**[[Scoliosis]] [[screening]]** is a public health strategy aimed at the early detection of spinal curvature abnormalities, especially *idiopathic scoliosis*, in asymptomatic children and adolescents.

===== 🔍 Core Elements =====
  * **Target population**: School-aged children, typically between 10 and 14 years old.
  * **Primary test**: Forward Bending Test (FBT or Adams test).
  * **Measurement tool**: Scoliometer to quantify trunk rotation (angle of trunk rotation, ATR).
  * **Confirmatory test**: Radiographic evaluation (Cobb angle).
  * **Setting**: Usually performed in schools or primary care facilities.

===== 🎯 Goals =====
  * Detect scoliosis **before skeletal maturity**.
  * Enable **early non-surgical interventions** (e.g., bracing, physiotherapy).
  * Prevent **curve progression and structural deformity**.
  * Minimize long-term **functional, aesthetic, and psychological** impact.
  * Reduce the burden on **specialized services** (orthopedics, neurosurgery).

===== ⚠️ Controversies =====
  * **Low sensitivity** of visual-only screening → missed cases.
  * **High false-positive rate** → unnecessary anxiety and referrals.
  * **Cost-effectiveness** is debated.
  * Lack of **standardization** across countries and regions.
  * Potential for **overdiagnosis and overtreatment**.
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Ríos-de-Moya-Angeler et al. evaluate a scoliosis screening program (PANA) where attendance drops from 73.2% to 20.5% between age groups, and only 15.3% complete all phases
((Rios-de-Moya-Angeler R, Santonja-Medina F, Sanz-Mengibar JM, Ríos-Bernabé R, Hurtado-Avilés J, Santonja-Renedo F. Evaluation of a Primary Health Care Scoliosis Screening Program: A 9-Year Follow-Up Study. J Clin Med. 2025 May 30;14(11):3870. doi: 10.3390/jcm14113870. PMID: 40507630; PMCID: PMC12156459.)) 

**Conclusion: Evaluating effectiveness in a system with near-zero adherence is methodologically meaningless.**

> ❝ This is like reviewing the efficiency of a train that never arrives. ❞

===== 🧪 2. Methodological Fragility: Tiny Sample, Inflated Conclusions =====
From 881 initial subjects, only 127 were followed up — a biased 14.4%.  
Retrospective reliance on the **visual forward bending test (FBT)** without quantification undermines any clinical validity.

**Red flag:** You cannot draw robust conclusions from uncalibrated tools and a self-selected cohort.

===== 🎯 3. Diagnostic Tools Misused: FBT ≠ Gold Standard =====
Visual FBT had only **5.9% sensitivity**, with 11.1% false positives at age 13-14.  
Only 4% were positive when using a scoliometer >7°.

> ❝ It takes 9 years to learn a basic lesson: use an instrument, not your eyes. ❞

===== 🔁 4. Circular Reasoning and Policy Naivety =====
The study calls for better-trained staff and use of the scoliometer in schools, but fails to address:
  * Why participation plummeted
  * How to ensure long-term compliance
  * Barriers at the system or family level

**Policy fantasy:** More of the same won’t fix foundational flaws.

===== 🧠 5. Irrelevance for Specialists =====
No data on:
  * Curve progression
  * Radiographic classification
  * Referral to spine surgeons
  * Surgical need or outcomes

**Conclusion:** The study is disconnected from real-world scoliosis management and decision-making.

===== 💣 Final Verdict: A Postmortem, Not a Study =====
This is not a validation — it is an autopsy. With no useful correlation to patient-centered outcomes, this study:
  * Documents a failing program,
  * Avoids systemic analysis,
  * And proposes more of what already doesn’t work.

> ❝ Monitoring failure for a decade does not turn it into success. ❞