School screening and point prevalence of adolescent idiopathic scoliosis in 4000 Norwegian children aged 12 years

Background: School screening for adolescent idiopathic scoliosis (AIS) is discussed. The aim of the present study was to describe the point prevalence of AIS and to evaluate the effectiveness of school screening in 12-year-old children. Methods: Community nurses and physical therapists in the Southern Health region of Norway including about 12000 school children aged 12 years were invited to participate. All participating community nurses and physical therapists fulfilled an educational course to improve their knowledge about AIS and learn the screening procedure including the Adam Forward Bending Test and measurement of gibbus using a scoliometer. Results: Sub-regions including 4000 school children participated. The prevalence of idiopathic scoliosis defined as a positive Adam Forward Bending Test, gibbus > 7 degrees and primary major curve on radiographs > 10 degrees, was 0.55%. Five children (0.13%) had a major curve > 20 degrees. Bracing was not indicated in any child; all children were post menarche; four had Risser sign of 4, and one with Risser 1 did not have curve progression > 5 degrees at later follow-up. In one of these 5 children however, the major curve progressed to 45 degrees within 7 months after screening and the girl was operated. Conclusion: The point prevalence of AIS in 12-year old children is in agreement or slightly lower than previous studies. The screening model employed demonstrates acceptable sensitivity and specificity and low referral rates. Screening at the age of 12 years only was not effective for detecting patients with indication for brace treatment.