The Canadian Scoliosis Screening Coalition

School Screening Studies and Related Publications:

The following is a curated list.

1. ***Grivas TB, Vasiliadis E, Mazioti C, Mamzeri A, Papagianni D, Katzouraki G, Sekouris N. To Screen or Not to Screen: "False Positive" Cases-Can They Be Treated as Definitely False? Properly Selecting the Screening Age-Range Groups in Scoliosis Screening Programs. Healthcare (Basel). 2025 Mar 10;13(6):600. doi: 10.3390/healthcare13060600. PMID: 40150450; PMCID: PMC11942112."... This opinion paper provides a brief overview of the history of school scoliosis screening programs following the introduction. Methods: It outlines the international administrative policies of these programs, their impact on the frequency of surgical procedures, and the effects of discontinuing school-based scoliosis screenings...It appears that latitude which differentiates the sunlight influences melatonin secretion and modifies age at menarche, which is associated with the prevalence of IS. Age at menarche is considered a reliable prognostic factor for IS and varies in different geographic latitudes [13]. Consequently, the geographical latitude and menarche will determine the age range groups of children which will be screened. Traditionally the age group is including the fifth and sixth grade of primary school and seventh and eighth grade in high school, but this range must be adjusted according to the latitude of the place because the menarche differs at different latitudes....It has been reported [122] that the decision not to implement screening due to cost-effectiveness concerns is based on an outdated assumption—originally derived from an early study [123] that surgery is the only proven treatment option...Today, evidence demonstrates that signs and symptoms of scoliosis can be significantly improved through intensive inpatient exercise programs... It is also well-documented and widely accepted that bracing alters the natural course of IS [86,125,126,127,128,129,130,131,132,133,134], and that SSS programs reduce the number of patients requiring surgical intervention [86]...Conclusions One reason SSS programs have been discontinued is the occurrence of false positive cases. Many younger children are referred from these programs due to trunk asymmetry but actually have a straight spine or a Cobb angle below 10 degrees, leading to their classification as “false positives”. However, it is highly likely that some of these children may later develop IS as they grow, meaning they should not be definitively labeled as false positives...The recommended age group for screening is adjusted based on latitude, as the timing of menarche varies accordingly. It is advised to conduct screenings within a window of two years before and two years after the average age of menarche in a given country. Ultimately, SSS programs are strongly recommended due to their numerous benefits."
2. González-Ruiz JM, Mohamed N, Hassan M, Fald K, de Los Ríos Ruiz E, Pérez Cabello P, Redondo ÁR, da Rosa B, Burke TN, Westover L. Clinical and Topographic Screening for Scoliosis in Children Participating in Routine Sports: A Prevalence and Accuracy Study in a Spanish Population. J Clin Med. 2025 Jan 6;14(1):273. doi: 10.3390/jcm14010273. PMID: 39797357; PMCID: PMC11722016."...Conclusions: The clinical screening method showed superior sensitivity and balanced accuracy compared to ST screening. However, ST screening showed higher specificity and PPV, suggesting its potential as a complementary tool to reduce the high positive predictive value. These results highlight the importance of combining screening methods to improve the accuracy of the early detection of IS in physically active children, with the radiographic confirmation of the positive screened cases remaining essential for accurate diagnosis...."
3. Khadour FA, Khadour YA, Albarroush D. Association between postural habits and lifestyle factors of adolescent idiopathic scoliosis in Syria. Sci Rep. 2024 Nov 5;14(1):26784. doi: 10.1038/s41598-024-77712-z. PMID: 39500971; PMCID: PMC11538456. "...The results showed several statistically significant differences between the AIS case group and the healthy control group. A notably lower percentage of AIS participants reported having a normal standing posture than controls (46.8% vs. 72.7%)... the AIS group had lower self-reported participation rates in various sports and physical activities. However, no significant differences were found between groups for time spent in extracurricular classes, proportions with normal vision, schoolbag-carrying habits, or general health status..."
4. Fu X, Meng S, Huang X, Li W, Ye B, Chen S. The prevalence of scoliosis among adolescents in China: a systematic review and meta-analysis. J Orthop Surg Res. 2024 Sep 28;19(1):585. doi: 10.1186/s13018-024-05077-0. PMID: 39342221; PMCID: PMC11437733.
5. Yang J, Huang S, Cheng M, Tan W, Yang J. Postural habits and lifestyle factors associated with adolescent idiopathic scoliosis (AIS) in China: results from a big case-control study. J Orthop Surg Res. 2022 Oct 29;17(1):472. doi: 10.1186/s13018-022-03366-0. PMID: 36309689; PMCID: PMC9618226."...Conclusions In conclusion, inappropriate school desk height, anterior pelvic tilt and lateral right sleeping position are associated with elevated AIS risk, while up-straight sitting and changing classroom sitting positions regularly are associated with decreased AIS risks. These findings could inform future school AIS prevention programs."
6. Luk KD, Lee CF, Cheung KM, Cheng JC, Ng BK, Lam TP, Mak KH, Yip PS, Fong DY. Clinical effectiveness of school screening for adolescent idiopathic scoliosis: a large population-based retrospective cohort study. Spine (Phila Pa 1976). 2010 Aug 1;35(17):1607-14. doi: 10.1097/BRS.0b013e3181c7cb8c. PMID: 20453727."Methods. A total of 157,444 students were eligible for a biennial scoliosis screening, and their screening results and medical records up to 19 years of age were available. Students first had forward bending test and angle of trunk rotation (ATR) performed. Those with ATR between 5° and 14° or signs of adolescent idiopathic scoliosis were assessed by moiré topography regularly. Students with an ATR ≥15°, ≥2 moiré lines, or significant clinical signs were referred for radiography and had their Cobb angle measured.
   Results. Of the 115,190 screened students in the cohort, 3228 (2.8%, 95% confidence interval [CI] = 2.7%–2.9%) were referred for radiography. At the final follow-up, the positive predictive values were 43.6% (41.8%–45.3%) for a Cobb angle ≥20° and 9.4% (8.4%–10.5%) for needing treatment, while the sensitivities were 88.1% (86.4%–89.6%) and 80.0% (75.6%–83.9%), respectively....Conclusion: This is the largest study that has demonstrated that school scoliosis screening in Hong Kong is predictive and sensitive with a low referral rate. Screening should thus be continued in order to facilitate early administration of conservative treatments."
7. Chen C, Yu R, Xu W, Li Z, Li Y, Hu R, Zhu X. A Practical Study of Diagnostic Accuracy: Scoliosis Screenings of Middle School Students by a Trained Nurse With a Smartphone Versus a Spine Surgeon With a Scoliometer. Spine (Phila Pa 1976). 2020 Mar 1;45(5):E266-E271. doi: 10.1097/BRS.0000000000003256. PMID: 31568349.
8. Yılmaz H, Zateri C, Kusvuran Ozkan A, Kayalar G, Berk H. Prevalence of adolescent idiopathic scoliosis in Turkey: an epidemiological study. Spine J. 2020 Jun;20(6):947-955. doi: 10.1016/j.spinee.2020.01.008. Epub 2020 Jan 20. PMID: 31972303.
9. Chen C, Yu R, Xu W, Li Z, Li Y, Hu R, Zhu X. A Practical Study of Diagnostic Accuracy: Scoliosis Screenings of Middle School Students by a Trained Nurse With a Smartphone Versus a Spine Surgeon With a Scoliometer. Spine (Phila Pa 1976). 2020 Mar 1;45(5):E266-E271. doi: 10.1097/BRS.0000000000003256. PMID: 31568349. “Conclusion. This study revealed that smartphone-aided screening for scoliosis is risky.” Level of Evidence: 3
10. Adamczewska K, Wiernicka M, Malchrowicz-Mośko E, Małecka J, Lewandowski J. The Angle of Trunk Rotation in School Children: A Study from an Idiopathic Scoliosis Screening. Prevalence and Optimal Age Screening Value. Int J Environ Res Public Health. 2019 Sep 16;16(18):3426. doi: 10.3390/ijerph16183426. PMID: 31527403; PMCID: PMC6765789. “Background: Idiopathic scoliosis is a deformity of the growing spine. It affects 2–3% of adolescents; yet its cause is still unknown. At the early stage of idiopathic scoliosis (IS), the signs are not very noticeable. That is why the primarily school-based screening for scoliosis is so important...”
11. Aulisa AG, Giordano M, Guzzanti V, Falciglia F, Pizzetti P, Toniolo RM. Effectiveness of school scoliosis screening and the importance of this method in measures to reduce morbidity in an Italian territory. J Pediatr Orthop B. 2019 May;28(3):271-277. doi: 10.1097/BPB.0000000000000611. PMID: 30807511. “Our results show that the school screening program was accurate and repeatable. Moreover, screening children for scoliosis using a simple test appears to be an effective means of early detection. Above all, the screening process effectively decreased morbidity in the territory at a negligible cost.”
12. Penha PJ, Ramos NLJP, de Carvalho BKG, Andrade RM, Schmitt ACB, João SMA. Prevalence of Adolescent Idiopathic Scoliosis in the State of São Paulo, Brazil. Spine (Phila Pa 1976). 2018 Dec 15;43(24):1710-1718. doi: 10.1097/BRS.0000000000002725. PMID: 29877996.
13. Moalej S, Asadabadi M, Hashemi R, Khedmat L, Tavacolizadeh R, Vahabi Z, Shariatpanahi G. Screening of scoliosis in school children in Tehran: The prevalence rate of idiopathic scoliosis. J Back Musculoskelet Rehabil. 2018;31(4):767-774. doi: 10.3233/BMR-171078. PMID: 29578478. “..Initial screening of the students was done in schools by health care provider or medical student who has been trained by a pediatrician to undergo a vertebral examination. Scoliometer for iPhone's smartphone has been used for measuring the angle of deviation...."
14. Hengwei F, Zifang H, Qifei W, Weiqing T, Nali D, Ping Y, Junlin Y. Prevalence of Idiopathic Scoliosis in Chinese Schoolchildren: A Large, Population-Based Study. Spine (Phila Pa 1976). 2016 Feb;41(3):259-64. doi: 10.1097/BRS.0000000000001197. PMID: 26866739. “Conclusion: The prevalence rate of IS was 5.14% in our study. Screening of 13- to 14- and 14- to 15-year-old girls identified a significant number who could benefit from preventive treatment “
15. Yamamoto S, Shigematsu H, Kadono F, Tanaka Y, Tatematsu M, Okuda A, Iwata E, Koizumi M, Tanaka Y. Adolescent Scoliosis Screening in Nara City Schools: A 23-Year Retrospective Cross-Sectional Study. Asian Spine J. 2015 Jun;9(3):407-15. doi: 10.4184/asj.2015.9.3.407. Epub 2015 Jun 8. PMID: 26097656; PMCID: PMC4472589. “We believe that scoliosis screening in schools is useful for detection; however, screening programs are controversial owing to over referral of students who do not require further testing or follow-up...We selected Moiré topography as the scoliosis screening tool...Moiré topography, had a high false-positive rate...Although our screening cost was less than that for surgical intervention in Japan, it was twice as high as that in Minnesota, USA. Our study has highlighted the need for further research in the area of reduction of the false-positive rate of Moiré topography for scoliosis screening.”
16. Fong DY, Cheung KM, Wong YW, Wan YY, Lee CF, Lam TP, Cheng JC, Ng BK, Luk KD. A population-based cohort study of 394,401 children followed for 10 years exhibits sustained effectiveness of scoliosis screening. Spine J. 2015 May 1;15(5):825-33. doi: 10.1016/j.spinee.2015.01.019. Epub 2015 Jan 20. PMID: 25615844.“...scoliosis screening program can have sustained clinical effectiveness in identifying patients with adolescent idiopathic scoliosis needing clinical observation... scoliosis screening should be continued as a routine health service in schools or by general practitioners if there is no scoliosis screening policy.”
17. Adobor, R.D., Joranger, P., Steen, H. et al. A health economic evaluation of screening and treatment in patients with adolescent idiopathic scoliosis. Scoliosis 9, 21 (2014). https://doi.org/10.1186/s13013-014-0021-8 “...Scoliosis screening programs are considered to be beneficial from a clinical point of view but are criticized for high costs due to high referral and treatment rates ... Results suggest that screening is cost saving, unless both treatment rates and surgical rates are very low in comparative non-screening scenarios... the present study indicates that costs increase in non-screening scenarios with high rates of surgery and lower rates of bracing.”
18. Płaszewski M, Bettany-Saltikov J. Are current scoliosis school screening recommendations evidence-based and up to date? A best evidence synthesis umbrella review. Eur Spine J. 2014 Dec;23(12):2572-85. doi: 10.1007/s00586-014-3307-x. Epub 2014 Apr 29. PMID: 24777669. “As the existing recommendations supporting screening are based on moderate quality evidence whilst the recommendations against screening are based on low-quality evidence, the latter recommendations appear to be both unconvincing and methodologically invalid.”
19. Yawn BP, Yawn RA. The estimated cost of school scoliosis screening. Spine (Phila Pa 1976). 2000 Sep 15;25(18):2387-91. doi: 10.1097/00007632-200009150-00019. PMID: 10984793. “Case-finding costs for screening were $24.66 per child screened (n = 2197), $3, 386.25 per child with a curve of 20 degrees or more (n = 16) and $10, 836.00 per child treated for scoliosis (n = 5).”
20. Koukourakis I, Giaourakis G, Kouvidis G, Kivernitakis E, Blazos J, Koukourakis M. Screening school children for scoliosis on the island of Crete. J Spinal Disord. 1997 Dec;10(6):527-31. PMID: 9438820.
21. Soucacos PN, Soucacos PK, Zacharis KC, Beris AE, Xenakis TA. School-screening for scoliosis. A prospective epidemiological study in northwestern and central Greece. J Bone Joint Surg Am. 1997 Oct;79(10):1498-503. doi: 10.2106/00004623-199710000-00006. PMID: 9378735.
22. Yong F, Wong HK, Chow KY. Prevalence of adolescent idiopathic scoliosis among female school children in Singapore. Ann Acad Med Singap. 2009 Dec;38(12):1056-63. PMID: 20052440. “...Conclusions: The study showed a significant increase in the prevalence rates of scoliosis in the 10- to 11-year-old female students and again a significant increase in the prevalence rates in the 12- to 13-year-old female students... it was recommended that screening for females be performed every year commencing at 10 years old (Primary 5) until 13 years old (Secondary 2).”
23. Grivas TB, Vasiliadis E, Savvidou OD, Triantafyllopoulos G. What a school screening program could contribute in clinical research of idiopathic scoliosis aetiology. Disabil Rehabil. 2008;30(10):752-62. doi: 10.1080/09638280802041086. PMID: 18432433. “...Scoliosis school screening (SSS) programs have clinically benefited many children through early detection and treatment...SSS should be adopted by policy makers, because its scope goes beyond the identification of IS at an early stage, contributing significantly into the research for IS aetiology. “