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Scoliosis

Scoliosis Screening: A Review of Current Evidence, Worldwide Practices, and Recommendations for Implementation Across Canada

Teaser: 

Caitlyn Dunphy, MPT, 1 Marie Anne Keenan, BSc candidate,2 Hunter Cole David Arulpragasam, BSc candidate,3 Jean Albert Ouellet, MD, FRCS(C),4 Kevin Smit, MD, FRCS(C),5 Ron El-Hawary, MD, MSc, FRCS(C),6 Andrea Mary Simmonds, MD, MHSc, FRCS(C),7

1BC Children’s Hospital Orthopaedic Spine Clinic.
2University of Victoria, Research Student, Department of Orthopaedic Surgery, BC Children’s Hospital.
3University of Toronto, Research Student, Department of Orthopaedic Surgery, BC Children’s Hospital.
4McGill University Health Centre/ Shriners Hospital for Children - Canada.
5Pediatric Orthopedic Surgeon, CHEO, Associate Professor, Faculty of Medicine, University of Ottawa, Surgeon Scientist, CHEO Research Institute.
6Professor of Surgery (Orthopedics, Neurosurgery) Professor of Biomedical Engineering, Faculty of Medicine, Dalhousie University Chief of Pediatric Orthopedic Surgery, IWK Health.
7 Paediatric Spine & Orthopaedic Trauma Surgeon, British Columbia Children’s Hospital Clinical Assistant Professor, UBC Department of Orthopaedics.

CLINICAL TOOLS

Abstract: There is a lack of consensus about the merits of scoliosis screening and whether it is a beneficial strategy for both the patients and the healthcare system. With mounting concerns about long wait times across Canada for surgical correction of scoliosis, interest has grown in maximizing non-operative care. We have investigated the history of scoliosis screening and the controversies surrounding implementation of screening in a Canadian setting. We propose an optimal screening strategy.
Key Words: Scoliosis, scoliosis screening, early detection, conservative strategies.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
Screening can facilitate early diagnosis and treatment of scoliosis.
Early diagnosis of scoliosis increases opportunities for successful conservative treatment.
Conservative strategies may prevent the need for surgical intervention.
Scoliosis screening may improve access to care and reduce health care costs.
Early detection of scoliosis through school screenings is recommended for initiating timely and effective conservative treatments, such as bracing and physical therapy. This can significantly reduce the need for surgical interventions and associated healthcare costs.
A standardized, evidence-based screening protocol should be developed and implemented across all Canadian schools. This protocol should include clear guidelines on the use of screening tools, referral criteria, and follow-up procedures to ensure consistency and accuracy in detecting scoliosis.
School nurses, physical education teachers, and other relevant personnel should receive adequate resources and support for proper training in scoliosis screening.
Educational campaigns must raise awareness about the signs of scoliosis and the importance of school screenings for early detection among parents, teachers, and the general public.
Ongoing research and evaluation of the screening program should be conducted to assess its effectiveness, cost-benefit ratio, and impact on health outcomes.
Collaboration between healthcare providers, educators, policymakers, and scoliosis advocacy groups is essential to create a comprehensive and sustainable screening program.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, Scoliosis, scoliosis screening, early detection, conservative strategies

The Non-Operative Management of Scoliosis

Teaser: 

Brett Rocos, BSc (Hons), MB ChB, MD, FRCS (Tr & Orth),

Paediatric Spine Fellow, The Hospital for Sick Children, Toronto, ON.

CLINICAL TOOLS

Abstract:Scoliosis is a common condition that every primary care provider will encounter. There are many treatments available in its management, including observation, physical therapy, pain management strategies, casting, bracing and surgery. In this narrative review, the roles of each of the non-operative strategies in managing adult and paediatric scoliosis are explored, and the evidence supporting each is summarised. Scoliosis affects people at every stage of life, and an understanding of the treatments available will aid in counselling patients and making appropriate referrals.
Key Words: Scoliosis, conservative, paediatric, bracing, physiotherapy, alternative therapies, spine cast.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
• Scoliosis is common
• Most patients require observation only
• Patient information is essential
• Casting and bracing have roles in the growing skeleton only
• Physical therapy has limited evidence in both adult and paediatric deformity
• Alternative therapies have no proven use in the management of scoliosis
The majority of patients with scoliosis can be observed
Reliable patient information is critical
There is limited evidence that physiotherapy is effective, and no evidence that alternative therapies are effective in treating scoliosis
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, Scoliosis, conservative, pediatric, bracing, physiotherapy, alternative therapies, spine cast
Disclaimer: 
Disclaimer at the end of each page

The Role of Screening and Brace Management for Adolescent Idiopathic Scoliosis

Teaser: 

Kedar Padhye, MBBS, DNB (Ortho), 1Reza Ojaghi, MD, 2Fábio Ferri-de-Barros, MD, MSc, FSBOT, FSBOP (Hon.), FRCSC, FCS(ECSA),3

1 Clinical Fellow (Pediatric Spine Surgery)Division of Paediatric Surgery, Section of Orthopaedic Surgery, Alberta Children's Hospital, University of Calgary, Calgary, Alberta.
2Orthopaedic Surgery Resident, Department of Orthopedics, University of Ottawa, Ottawa, Ontario.
3 Department of Orthopedics, Alberta Children's Hospital, Calgary, Alberta.

CLINICAL TOOLS

Abstract: Adolescent Idiopathic Scoliosis (AIS) is defined as curvature of spine in the coronal plane with a Cobb angle of more than 10°. AIS affects 1-3% of children younger than 16 years of age. Less than 20% of those children will progress to severe deformity requiring interventions. Screening with clinical examination and selective radiographic assessment seems to be a cost-effective approach to filter specialist referrals but current literature is controversial. Evidence supports brace management of AIS for skeletally immature patients with primary scoliosis measuring 25°–40. The risk reduction for progression to the surgical range (deformity greater than 50 degrees) is 56%. Timely diagnosis and evidence-based brace management of AIS seem likely to reduce the surgical burden. The implementation of screening guidelines at the primary care level is a critical step.
Key Words: scoliosis; idiopathic; Brace treatment; conservative treatment; screening.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
Bracing is an effective but time sensitive intervention for managing AIS in skeletally immature patients with primary scoliosis measuring 25 to 40 degrees.
Clinical screening is required to identify AIS patients who eligible for bracing.
Improving access to bracing for eligible patients requires a collaborative approach involving primary care physicians and specialists.
1. A systematic collaborative approach involving primary care physicians for screening patients and referring to tertiary care ensures timely assessment and management for eligible patients.
2. Evidence supports brace management of AIS for skeletally immature patients with primary scoliosisl measuring 25°–40°, with the goal of preventing deformity progression to the surgical threshold.
3. A full time (18-23h/day) rigid brace treatment may mitigate the surgical burden of AIS by approximately 30%.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, Scoliosis, idiopathic, Brace treatment, conservative treatment, screening
Disclaimer: 
Disclaimer at the end of each page