🩺 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.

• 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.

• 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).

• 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 ¹⁾

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. ❞

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.

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. ❞

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.

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.

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. ❞