Next Article in Journal
Impact of Placental Grading on Pregnancy Outcomes: A Retrospective Cohort Study
Previous Article in Journal
The Interplay Between Cervicovaginal Microbiota Diversity, Lactobacillus Profiles and Human Papillomavirus in Cervical Cancer: A Systematic Review
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Healthcare
Volume 13
Issue 6
10.3390/healthcare13060600
healthcare-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Opinion

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

by
Theodoros B. Grivas
1,*,
Elias Vasiliadis
2,
Christina Mazioti
3,
Aristea Mamzeri
4,
Despina Papagianni
5,
Galateia Katzouraki
6 and
Nikolaos Sekouris
7
1
Department of Orthopedics & Traumatology, “Tzaneio” General Hospital of Piraeus, 185 36 Piraeus, Greece
2
3rd Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, KAT Hospital, 145 61 Athens, Greece
3
“Tzaneio” General Hospital of Piraeus, 185 36 Piraeus, Greece
4
TOMY Attica Square, 104 45 Athens, Greece
5
Special Primary School of Rafina, 190 09 Rafina, Greece
6
Spinal Department of Hygeia Hospital, 4 Erythrou Stavrou, 151 23 Maroussi, Greece
7
The 1st Department of Orthopedics, P. & A. Kyriakou Children’s Hospital, 23 Levadeias, 115 27 Athens, Greece
*
Author to whom correspondence should be addressed.
Healthcare 2025, 13(6), 600; https://doi.org/10.3390/healthcare13060600
Submission received: 27 January 2025 / Revised: 25 February 2025 / Accepted: 6 March 2025 / Published: 10 March 2025
Browse Figures
Review Reports Versions Notes

Abstract

:
Background/Objectives: 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. Results: The primary focus is on analyzing the role of “false positive” cases detected during the Adam’s bending test, which has contributed to the discontinuation of these programs in certain countries. This focused discussion is based on the impact of growth on the relationship between spinal and rib cage deformities. Furthermore, we propose the selection of the optimal age range for screening, considering the correlation between idiopathic scoliosis prevalence and geographical latitude. Conclusions: Lastly, we emphasize the importance of continuing scoliosis screening programs in schools.

1. Introduction

Idiopathic scoliosis (IS) is a three-dimensional deformity of the spine and thorax. In reality, it is a four-dimensional condition, with the fourth dimension being time—scoliosis persists throughout a person’s lifetime. The exact cause of IS remains unclear [1]. Various concepts and hypotheses have been proposed regarding its development, drawing from studies on genetics, the central nervous system (CNS), spinal growth and bone metabolism, metabolic pathways, biomechanics, and other factors. However, these studies primarily explain the mechanisms underlying scoliosis rather than its etiology [2,3,4].
The prevalence of IS varies significantly across studies and countries, ranging from 0.93% to 12% [5]. This variation can be attributed to various biological and geographical factors [1]. However, several publications report a narrower prevalence range in the general population [6,7,8,9,10,11]. These studies do not provide a comprehensive analysis of the full spectrum of IS prevalence or the reasons behind its variability, except for a limited number of publications, such as Wong et al. (2005) [12]. Wong et al. reported that prevalence rates were low at ages 6 to 7 and 9 to 10 but increased rapidly to 1.37% and 2.22% among girls aged 11 to 12 and 13 to 14, respectively. They also found that the false-positive rate in girls decreases with age, likely due to the concurrent increase in scoliosis prevalence [12].
It has been reported that the age at menarche is associated with the prevalence of idiopathic scoliosis (IS) [13]. A later age at menarche corresponds to a higher prevalence of adolescent idiopathic scoliosis (AIS). Moreover, IS prevalence is thought to be influenced by geographic latitude and sunlight exposure, which affect the age at menarche and, consequently, the development of AIS. Additionally, the age at menarche varies across countries, which may partially explain the wide variation in reported IS prevalence worldwide [13].
The treatment of IS varies based on curve severity, age at presentation, and growth potential [14,15,16,17,18]. Management begins with prevention, primarily through early recognition of the deformity via school scoliosis screening (SSS). The primary goal of modern SSS programs is to identify individuals with truncal asymmetry (TA) and/or unrecognized IS at an early stage when less invasive treatment is most effective. Additionally, the screening process has been shown to reduce morbidity within the population at a negligible cost [19].
For mild to moderate scoliotic curves, physiotherapeutic-specific scoliosis exercises (PSSE), bracing, or a combination of both non-operative treatments aim to prevent progression or even improve the deformity to some extent [20]. In cases of severe IS, surgical intervention is required, utilizing various techniques and approaches, particularly for skeletally immature patients [21,22,23].

2. The History of School Scoliosis Screening (SSS)

The preventive screening for scoliosis as part of general health assessment programs for young people, particularly school children, began in Europe at the start of the 20th century. In Greece, school doctors also examined children for scoliosis. Evidence suggests that such programs were implemented in various European countries and cities, as documented in the booklet H ΣKOΛIΩΣIΣ, written by Dr. Em. N. Lambadarios and published in Athens in 1915 by Thanos Tzavelas (Figure 1). The recorded locations included Hamburg, Lausanne, Paris, Athens, and Sweden.
Fifty years later, in 1963, the SSS programs was initiated in Aitken, Minnesota, under the leadership of Dr. Lonstein. He emphasized the significant benefits of early screening, stating that detecting spinal curves in their early stages allows for timely intervention, including bracing, which helps prevent further progression and reduces the likelihood of future surgical correction. Routine scoliosis screening in Minnesota schools has proven to be an effective method for the early detection of spinal deformities. Regarding the SSS program, Dr. Lonstein described the screening process as “a rapid and easy test—a 30 s investment for a lifetime of dividends” [24,25,26].
Dr. Dean MacEwen played a key role in the early development of voluntary SSS programs by implementing them in Delaware schools during the 1960s [27].
In 1975, Dr. Panagiotis Smyrnis organized and conducted the first SSS program in Athens, Greece. A total of 3494 children aged 12–14 from the Attica region were visually examined using the Adams forward bending test. The study found that 10% of the children tested positive clinically, while radiologically confirmed scoliosis (curves of 10 degrees or more) was observed in 4.6% of girls and 1.1% of boys. Additionally, the study noted that children with blond hair and blue eyes were more prone to scoliosis compared to those with darker features.
Dr. Smyrnis emphasized that the bending test remains the most commonly used and accessible screening method due to its simplicity, even for non-experts. He also highlighted the importance of a second evaluation before proceeding with radiological examination, as well as the benefit of conducting screenings in a comfortable and familiar setting. He stated, “It should be emphasized that apart from the size of the hump, its spinal level has clinical significance”. Furthermore, he recommended that mass screening should focus on children aged 10–13, as 85% of clinically significant idiopathic scoliosis (IS) cases emerge during this period. The study also observed a 3:1 ratio between clinically and radiologically positive cases [28,29].
The results of this program were first presented at the third “N. Giannestras” Symposium in September 1975 in Athens, Greece [29,30], and later at the sixth Symposium held at the Cardio-thoracic Institute, Brompton Hospital, London, on 17–18 September 1979 [31].
Consequently, similar SSS programs were implemented by orthopedic teams interested in conducting SSS in various Hellenic cities. The SSS program at “Thriasio” Hospital was conducted from 1996 to 2009, followed by the “Tzaneio” Hospital program from 2009 to 2019. During this period, TBG served the Hellenic National Health System, examining a total of 24,223 children. Further details on the history and reported outcomes of Hellenic SSS programs up to the year 2000 can be found in the book School Screening in Greece [28].

3. Policies of Administration of SSS Programs

Global policies on the implementation of SSS programs exhibit both encouraging and discouraging trends, reflecting inconsistency in approach [32,33]. The necessity of an SSS program for IS was initially debated [34,35,36,37].
In the Netherlands, Pruijs et al. (1996) reported that budget cuts had led to a decline in the frequency of health checks in many districts compared to the 1980s. These checks included the forward-bending test, a key component of scoliosis screening [38].
For years, the U.S. Preventive Services Task Force (USPSTF) maintained a negative stance on SSS implementation. In 1996, it found insufficient evidence to support or oppose routine screening for asymptomatic adolescents with IS, issuing an “I” recommendation (indicating insufficient evidence) [39]. By 2004, the USPSTF shifted its position, recommending against routine screening for asymptomatic adolescents [40,41,42].
This change was met with concern from major medical societies, including the American Academy of Orthopaedic Surgeons (AAOS), the Scoliosis Research Society (SRS), the American Academy of Pediatrics (AAP), and the Pediatric Orthopaedic Society of North America (POSNA). These societies criticized the USPSTF’s updated recommendation, emphasizing that it was made without substantial changes in the existing literature, without revised position statements from key medical societies, and without significant input from specialists who regularly treat children with IS. The AAOS, SRS, POSNA, and AAP did not endorse any formal recommendations against SSS based on the available evidence.
In its most recent report, the USPSTF acknowledged that screening can detect AIS. Furthermore, it recognized that bracing and possibly exercise-based treatments can slow or prevent the progression of spinal curvature during adolescence [43].
In 2007, the topic of SSS was addressed at the SOSORT meeting, leading to a consensus paper that aimed to summarize the current state of SSS and outline areas of agreement among 35 health professionals worldwide. The SOSORT endorsed SSS programs [33].
In 2010, during the SRS meeting in Kyoto, the validity of SSS programs was questioned. The SRS presidential line assigned eight international experts to investigate SSS from a global perspective. The SRS International Task Force on Scoliosis Screening examined the clinical effectiveness, technical program effectiveness, cost-effectiveness, and treatment outcomes. Their final conclusion was that SSS programs should be recommended [33].
The implementation of SSS is closely tied to non-operative treatment for Idiopathic Scoliosis (IS). At the 48th annual SRS meeting in Lyon, the notable BRAIST study was presented. Dr. Weinstein, the presenter, reported that bracing adolescents with moderate IS effectively reduced the number of patients requiring surgery. The study also showed a positive correlation between the number of hours spent wearing the brace and its success. The findings suggested that early detection, brace compliance, improved bracing indications, cost savings from bracing versus surgery, and a reconsideration of screening policies were crucial [44,45,46,47,48,49].
Recently, there has been a global trend in favor of implementing SSS programs, including endorsement from the USPSTF. It seems that the momentum is shifting back toward scoliosis screening [50].
Our training center at the “Tzaneio” hospital in Piraeus, which trains certified SSS program examiners, was officially recognized by the Hellenic State (Government Gazette No. Sheet 4168, Issue B, 30 November 2017) as the “Special Training Center for the Implementation of the Student Screening Program for Scoliosis and Other Spinal Deformities”.
In 2012, Plaszewski et al. analyzed various countries’ approaches to SSS based on publications up until that year [51].
In North America, fewer than half of the U.S. states have legislated SSS programs, and there is no nationwide requirement or standard for screening [14,25,52,53,54]. Canada introduced SSS programs in the 1970s, but these were gradually stopped. A recent article highlights that “Canada no longer has regular childhood screening for scoliosis, and other forms of prevention are not receiving the attention that surgery does. Some doctors are advocating for change” (Oct 2023) [55].
In Australia, SSS was introduced intermittently, but by the early 1990s, most programs were abandoned, with medical societies now advocating for a National Self-Detection Program for Scoliosis [56].
In Asia, countries like India [57], Saudi Arabia [58], Hong Kong, and parts of China have active SSS programs, with Hong Kong incorporating it into their Student Health Service since 1995 [59,60,61,62,63]. Singapore has included routine SSS in its national school health program since 1981 [12,64]. Other Southeast Asian countries, such as Malaysia [65,66], Indonesia [67], Vietnam [68], and Korea [69,70], occasionally carry out localized SSS programs. Japan has a mandatory SSS program, though it is organized locally [71].
In Africa, Nigeria has implemented an SSS program [72].
In South America, some Brazilian cities occasionally implement SSS programs [73,74], while Chile has carried out an SSS program in its metropolitan region [75].
In Europe, policies and legislation regarding SSS vary. The UK and Poland do not have a national policy, while countries like Sweden [76], Spain [6], the Netherlands [38], Italy [29], Greece [77,78,79,80,81], Bulgaria [82], Turkey [83,84], and Israel [85] offer SSS on a voluntary basis.

4. The Impact of Screening on Frequency of Surgical Treatment

The previous data on this issue seem somewhat inconsistent and inconclusive. For instance, in Minnesota, USA, where SSS is implemented, a decline in the frequency of IS surgeries was observed from 1974 to 1979 [25]. Torell et al. (1981) reported that SSS led to a reduction in the number of IS patients requiring surgery [86]. In another study [53], data were provided on the frequency of surgical treatment per thousand children screened over seven or more years from three US states: Kansas and Virginia showed no clear pattern, while in Minnesota, surgery rates decreased until 1981–82, after which they increased again [54]. Many European studies, however, provide stronger evidence of the positive impact of conservative treatment on reducing the frequency of IS surgeries. When high-quality conservative treatment is available, the incidence of surgery can be significantly reduced [87,88,89,90,91,92,93,94,95,96,97,98,99,100,101].

5. The Impact of Discontinuation of SSS

Beausejour et al. (2007) reported a concerning outlook on how the discontinuation of SSS programs impacted referral patterns for patients with AIS [102]. In a cross-sectional study conducted at a pediatric hospital’s orthopedic outpatient clinic in Canada, they assessed all patients referred for suspected AIS. The aim was to evaluate how the current referral practices compared to those before SSS programs were discontinued. Out of 489 patients referred with suspected AIS, 206 (42%) had no significant deformity (Cobb angle < 10 degrees), making these referrals inappropriate. Among patients with confirmed AIS, 91 (32%) were referred too late for proper brace treatment. The study concluded that the pause of SSS programs has resulted in suboptimal referral practices in orthopedic care for AIS [102]. Similarly, Ohrt-Nissen et al. (2016) noted that, without SSS programs, patients referred by GPs for AIS evaluation tended to have more severe curvature compared to those in systems with SSS [103]. In Norway, the frequency of brace treatment has decreased, while surgery rates have risen since the end of SSS programs, as highlighted by Adobor et al. (2012) [104]. Cho et al. (2018) found that in South Korea, patients with suspected AIS are increasingly referred late or inappropriately to tertiary centers due to the absence of SSS [105]. This outcome was widely anticipated and demonstrates how a shift toward epidemiology over early prevention and diagnosis can have detrimental effects. In a society that prioritizes people’s well-being, prevention should be a standard policy, not just a focus on statistics, epidemiology, or costs. We must recall the ancient Greek principle that “man is the measure of all things”, meaning the value of any decision or system should always center on the human being above all else.

6. The Reasons of SSS Discontinuation

Children with truncal asymmetry are referred to a specialized scoliosis clinic (such as those in hospitals or other medical organizations) for further assessment. The SSS team has pre-prepared and printed invitation letters for re-assessment, which are given to the school headmaster or directly to the examined children to pass on to their families.
Growth significantly affects the relationship between thoracic and spinal deformity in girls with IS. This should be considered when assessing spinal deformity using surface measurements, like a scoliometer. Research shows that, during growth, rib cage deformity occurs before spinal deformity in IS scoliogenesis [106].
The introduction of the Rib Index (RI) has provided valuable insights through statistical analysis, particularly the correlation between the Cobb angle and the RI in radiographs from referrals in our SSS programs. Approximately 30% of younger girls referred from our SSS program (under age 13) with an ATR of 7 degrees or more had either a straight spine or a Cobb angle of less than 10 degrees. In this younger age group, the correlation between clinical deformity (such as truncal asymmetry) and radiographic measurements (like the Cobb angle) is not statistically significant. However, this correlation is significant in older girls aged 14–18, as shown in Figure 2.
Growth appears to play a key role in the relationship between rib cage and spinal deformity in girls with IS. The study findings suggest that the correlation between thoracic deformity and spinal deformity is weak in younger children, indicating that rib cage deformity develops before spinal deformity in the progression of IS [106,107]. As shown in Figure 2, an RI of 2.5 corresponds to a Cobb angle of less than 10 degrees in girls aged 7–13. This indicates a notably deformed thorax [106]. Therefore, younger children identified with surface deformity using a scoliometer, but without a confirmed scoliotic curve on radiographs, are at risk for developing IS and must be monitored, not dismissed from follow-up.
This recommendation is supported by findings from Nissinen et al. (1993) in their longitudinal study [108]. Without our screening program, which included younger children alongside the typical age group, these conclusions would not have been possible. The introduction of the RI and its correlation with the Cobb angle allows us to more accurately determine the age range of children who should be monitored at the scoliosis clinic.
Healthcare 13 00600 g002
Figure 2. The correlation to clinical deformity (rib index) and to Cobb angle is not statistically significant in girls less than 13 yrs. old, while in older SSS referred girls aged 14–18 years old it is, (from our citation no [109,110]).
Figure 2. The correlation to clinical deformity (rib index) and to Cobb angle is not statistically significant in girls less than 13 yrs. old, while in older SSS referred girls aged 14–18 years old it is, (from our citation no [109,110]).
Healthcare 13 00600 g002
Our referral guidelines for re-examination are as follows: if the child is under 14 years old and the ATR is 5–6 degrees or more, or if the child is 14 or older and the ATR is 5 degrees or more. Children referred to the scoliosis clinic from the SSS programs undergo both clinical and radiographic evaluations, as needed.
In a lecture published in the referenced book [28], Dr. Smyrnis (2000) pointed out that the most critical age for mass screening is between 10 and 13 years old, where a 3:1 ratio is typically observed between children with clinically and radiologically positive results. The group of younger children who are referred from SSS programs for asymmetric trunk signs, but who show a straight spine or less than a 10-degree Cobb angle, are often considered “false positives” after being examined with the Adam’s bending test. However, these children may not actually be false positives, as they could develop IS as they grow, so they should not be dismissed as such. This lack of understanding, along with financial factors, likely led several medical systems to discontinue their SSS programs, as observed in the study by Yawn et al. (1999) [32]. They reported that SSS identified some children who required treatment but referred many others who did not, and this should be taken into account when making decisions about SSS. Publications like this created a negative perception of SSS, which aligns with the fact that some younger children may show trunk asymmetry without having scoliosis in their spine. The Yawn et al. study confirmed this, based on a retrospective cohort study of children who attended kindergarten or first grade in public or private schools in Rochester, MN, between 1979 and 1982.
Another reason for the unfavorable assessment of SSS value was the narrower age range of children examined in their programs, compared to our SSS program [111]. This limitation prevented them from recognizing that younger children with asymmetry during the Adam’s bending test, but no scoliosis, might later develop spinal deformities as they grow.
This more restricted age range (11–14 years old, corresponding to fifth, sixth, and seventh grades) also led to questions about the optimal cutoff point for referral to scoliosis clinics based on scoliometer readings in SSS. The “false positive” cases, where children exhibited a hump but had no spine deformity (spine straight or Cobb angle under 10 degrees), caused significant inconvenience for both doctors and parents, who invested time and money in specialized re-examinations far from their homes. Additionally, the unnecessary radiographs and the radiation exposure were seen as both costly and potentially harmful to the health of growing children. Moreover, the forward-bending test itself was criticized for its unreliability in diagnosing scoliosis [112]. Interestingly, the same study reported that among 121 spinal deformities with an initial Cobb angle less than 10 degrees, 44 (35.8%) progressed, and of 29 scoliotic deformities with initial Cobb angles between 10 and 20 degrees, 14 (48.3%) progressed, with a difference of at least 5 degrees in more than one examination [112].

7. Which Age Group Must Be Screened

Melatonin, “the light of night”, is secreted from the pineal gland principally at night. It is involved in sexual maturation in females [113]. Abnormally high or pharmacologic concentrations of melatonin in women are associated with altered ovarian function and anovulation. Melatonin acts in gonads indirectly, reducing the secretion of gonadotropins and mainly LH [114]. The menarche is related with episodic secretion of LH during the night [115,116]. Melatonin may play a role in the timing of puberty. The onset of puberty in humans may be related to the decline in melatonin secretion that occurs as children grow [117]. Therefore, increased melatonin levels inhibit sexual maturation in females. In northern latitude countries this sexual maturation happens later [118], due to poor light environmental conditions resulting in increased IS prevalence. It is hypothesized that the increased levels of melatonin in northern countries with poor light environmental conditions are reducing the secretion of LH and cause delayed age at menarche. Dossuse et al. 2013, reported that women born at lower latitudes or in regions with higher annual or spring/summer UVR dose had a 3–4 months earlier menarche than women born at higher latitudes or in regions with lower UVR [119].
In addition, the regression curves of prevalence of IS by latitude and age at menarche by latitude are of similar pattern [13]. Age at menarche is considered a reliable prognostic factor for IS development and progression [13,120], and varies in different geographic latitudes. A late age at menarche is parallel with a higher prevalence of AIS. This phenomenon is also observed in women with visual deficiency, and in this female group the prevalence of scoliosis is increased [121]. Pubarche appears later in girls that live in northern latitudes and thus prolongs the period of spine vulnerability, while other scoliogenic factors are contributing to the development of AIS.
A possible role of geography in the pathogenesis of IS was reported [13]. 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.

8. Why We Must Continue School Screening Programs

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. However, as noted by Hawes (2003), this study does not provide a scientifically justified basis for that conclusion [122].
Today, evidence demonstrates that signs and symptoms of scoliosis can be significantly improved through intensive inpatient exercise programs [124], and that the rate of progression can be substantially reduced [125]. Moreover, the incidence and prevalence of surgery can be significantly lowered when high-quality conservative treatment is available [97,98,99].
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].
Psychosocial health and body image concerns play a crucial role in treatment adherence and patient satisfaction, particularly among adolescents. Research suggests that psychosocial distress and body image disturbances are less pronounced in patients with strong social or family support, regular exercise habits, or good psychological well-being [135]. Additionally, SSS programs provide an opportunity to identify and document other developmental abnormalities.
Collectively, these studies support the hypothesis that school screening is justified—not only to detect and conservatively treat mild and moderate spinal curvatures but also to identify younger children with truncal asymmetry who may later develop scoliosis. Furthermore, evidence suggests that screening programs have effectively reduced morbidity at a negligible cost in regions where SSS has been implemented [19].

9. 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.
In areas where SSS programs have been discontinued, referrals have become less effective—either delayed or inappropriate for conservative treatment—leading to an increase in the number of surgical interventions. On the other hand, implementing SSS programs has significantly reduced the need for surgery, especially in regions where high-quality conservative treatment is available.
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.

Author Contributions

T.B.G.: conceptualization and writing—original draft preparation; review and editing; E.V., C.M., A.M., D.P., G.K. and N.S.: participation in our SSS program, review. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

No new data were created or analyzed in this study.

Acknowledgments

The first author, (TBG), wishes to express gratitude and acknowledge all the colleagues who have participated in our school scoliosis screening program over the years. Their voluntary support has contributed not only to the prevention of idiopathic scoliosis but also to enhancing the quality of life for children and adolescents in this country. Furthermore, their assistance played a crucial role in collecting the data that served as the foundation for several new concepts discussed in this opinion paper. The list of names follows: Papadakis Stamatios, Chandrinos Michael, Vynichakis George, Lykouris Dimitrios, Vasiliadis Elias, Kaspiris Angelos, Deimentes Panagiotis, Skouteli Myrto, Mazioti Christina, Mamzeri Aristea, Papagianni Despoina, Katarachia Eleni, Katopodi Anastasia, Mparka Elissavet, Grozou Anna, Noutsos George, Mouzakis Vasileios, Triantafyllopoulos George, Tsilimidos Gerasimos, Kastrinis Alexandros, Theodosopoulos Evangelos, Katzouraki Galateia, Benekou Christina, Papathanasiou Eleni-Evaggelia, Protopapadakis George, Dimitrakis Nikolaos, Sorolopidou Kalliroi, Fryda Zoi, Armakola Filomeni, Potamiti Eleni, Paspati Ioanna, Skaftourou Eva, Sekouris Nikolaos, Kosti Melpomeni, Gocha Magdalene, Melissaridi Dimitra, Papagiannakopoulou Leto, Lykissas Marios, Papadopoulos Elias.

Conflicts of Interest

The authors declare that they have no conflict of interest concerning this article.

Abbreviations

AISAdolescent Idiopathic Scoliosis
ATRAngle of Trunk Rotation
DRCSDouble Rib Contour Sign
ISIdiopathic Scoliosis
RIRib Index
SSSSchool Scoliosis Screening
TATruncal Asymmetry

References

  1. Cheng, J.C.; Castelein, R.M.; Chu, W.C.; Danielsson, A.J.; Dobbs, M.B.; Grivas, T.B.; Gurnett, C.A.; Luk, K.D.; Moreau, A.; Newton, P.O.; et al. Adolescent idiopathic scoliosis. Nat. Rev. Dis. Primers 2015, 1, 15030. [Google Scholar] [CrossRef] [PubMed]
  2. Wang, W.J.; Yeung, H.Y.; Chu, W.C.-W.; Tang, N.L.-S.; Lee, K.M.; Qiu, Y.; Burwell, R.G.; Cheng, J.C.Y. Top theories for the etiopathogenesis of adolescent idiopathic scoliosis. J. Pediatr. Orthoped. 2011, 31, S14–S27. [Google Scholar] [CrossRef]
  3. Burwell, R.G.; Dangerfield, P.H.; Moulton, A.; Grivas, T.B.; Cheng, J.C. Whither the etiopathogenesis (and scoliogeny) of adolescent idiopathic scoliosis? Incorporating presentations on scoliogeny at the 2012 IRSSD and SRS meetings. Scoliosis 2013, 8, 4. [Google Scholar] [CrossRef] [PubMed]
  4. Lowe, T.G.; Edgar, M.; Margulies, J.Y.; Miller, N.H.; Raso, V.J.; Reinker, K.A.; Rivard, C.H. Etiology of idiopathic scoliosis: Current trends in research. J. Bone Jt. Surg. Am. 2000, 82, 1157–1168. [Google Scholar] [CrossRef]
  5. Nissinen, M.; Heliovaara, M.; Ylikoski, M.; Poussa, M. Trunk asymmetry and screening for scoliosis: A longitudinal cohort study of pubertal schoolchildren. Acta Paediatr. 1993, 82, 77–82. [Google Scholar] [CrossRef] [PubMed]
  6. González-Ruiz, J.M.; Mohamed, N.; Hassan, M.; Fald, K.; Ruiz, E.d.e.-L.R.; Cabello, P.P.; Bruna da Rosa, Á.R.R.; Burke, T.N.; 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, 14, 273. [Google Scholar] [CrossRef]
  7. Hoelen, T.A.; Evers, S.M.A.A.; Arts, J.J.; Willems, P.C.; van Mastrigt, G.A.P.G. BMC The societal burden associated with adolescent idiopathic scoliosis: A cross-sectional burden-of-disease study. BMC Public Health 2024, 24, 3065. [Google Scholar] [CrossRef] [PubMed]
  8. Petrosyan, E.; Fares, J.; Ahuja, C.S.; Lesniak, M.S.; Koski, T.R.; Nader, S.; Dahdaleh, N.S.; El Tecle, N.E. Genetics and pathogenesis of scoliosis. N. Am. Spine Soc. J. 2024, 20, 100556. [Google Scholar] [CrossRef]
  9. Galbusera, F.; Cina, A.; Panico, M.; Bassani, T. The importance of curve severity, type and instrumentation strategy in the surgical correction of adolescent idiopathic scoliosis: An in silico clinical trial on 64 cases. Sci. Rep. 2021, 11, 1799. [Google Scholar] [CrossRef]
  10. Wang, J.; Zhu, C.; Ai, Y.; Huang, Y.; Chen, Q.; Ding, H.; Feng, G.; Liu, L.; Song, Y. The effect of brace treatment history on bone density in preoperative patients with adolescent idiopathic scoliosis (AIS) assessed by vertebral bone quality (VBQ) score: A retrospective propensity score-matched analysis. BMC Musculoskelet. Disord. 2024, 25, 682. [Google Scholar] [CrossRef]
  11. Konieczny, M.R.; Senyurt, H.; Krauspe, R. Epidemiology of adolescent idiopathic scoliosis. J. Child. Orthop. 2013, 7, 3–9. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
  12. Wong, H.K.; Hui, J.H.; Rajan, U.; Chia, H.P. Idiopathic scoliosis in Singapore schoolchildren: A prevalence study 15 years into the screening program. Spine 2005, 30, 1188–1196. [Google Scholar] [CrossRef]
  13. Grivas, T.B.; Vasiliadis, E.; Mouzakis, V.; Mihas, C.; Koufopoulos, G. Association between adolescent idiopathic scoliosis prevalence and age at menarche in different geographic latitudes. Scoliosis 2006, 1, 9. Available online: https://www.scoliosisjournal.com/content/pdf/1748-7161-1-9.pdf (accessed on 1 March 2025). [CrossRef] [PubMed]
  14. Lonstein, J.E.; Carlson, J.M. The prediction of curve progression in untreated idiopathic scoliosis during growth. J. Bone Jt. Surg. Am. 1984, 66, 1061–1071. [Google Scholar] [CrossRef] [PubMed]
  15. Soucacos, P.N.; Zacharis, K.; Gelalis, J.; Soultanis, K.; Kalos, N.; Beris, A.; Xenakis, T.; Johnson, E.O. Assessment of curve progression in idiopathic scoliosis. Eur. Spine J. 1998, 7, 270–277. [Google Scholar] [CrossRef] [PubMed]
  16. Wan, H.-T.S.; Wong, D.L.L.; To, C.-H.S.; Meng, N.; Zhang, T.; Cheung, J.P.Y. 3D prediction of curve progression in adolescent idiopathic scoliosis based on biplanar radiological reconstruction. Bone Jt. Open 2024, 5, 243–251. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
  17. Ilharreborde, B.; Steffen, J.S.; Nectoux, E.; Vital, J.M.; Mazda, K.; Skalli, W.; Obeid, I. Angle measurement reproducibility using EOS three-dimensional reconstructions in adolescent idiopathic scoliosis treated by posterior instrumentation. Spine 2011, 36, E1306–E1313. [Google Scholar] [CrossRef] [PubMed]
  18. Ferrero, E.; Lafage, R.; Vira, S.; Rohan, P.-Y.; Oren, J.; Delsole, E.; Guigui, P.; Schwab, F.; Lafage, V.; Skalli, W. Three-dimensional reconstruction using stereoradiography for evaluating adult spinal deformity: A reproducibility study. Eur. Spine J. 2017, 26, 2112–2120. [Google Scholar] [CrossRef]
  19. Aulisa, A.G.; Giordano, M.; Guzzanti, V.; Falciglia, F.; Pizzetti, P.; Toniolo, R.M. 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, 28, 271–277. [Google Scholar] [CrossRef]
  20. Negrini, S.; Donzelli, S.; Aulisa, A.G.; Czaprowski, D.; Schreiber, S.; de Mauroy, J.C.; Diers, H.; Grivas, T.B.; Knott, P.; Kotwicki, T.; et al. 2016 SOSORT guidelines: Orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord. Scoliosis 2018, 13, 3. [Google Scholar] [CrossRef]
  21. Wacker, E.M.; Schultz, L.; Leitsinger, N.; Jain, V.V.; Sturm, P.F. Growing Rod versus Posterior Spinal Fusion Treatment of Juvenile Idiopathic Scoliosis: Unique Characteristics and Surgical Outcomes. Healthcare 2024, 12, 489. [Google Scholar] [CrossRef] [PubMed]
  22. Balsano, M.; Vacchiano, A.; Spina, M.; Lodi, F.; Criveller, P.; Zoccatelli, F.; Corbolini, A.; Colombini, A.G.; Campisi, A.; Giovannetti, R.; et al. Anterior Vertebral Body Tethering (AVBT) in the Treatment of Adolescent Idiopathic Scoliosis: A Retrospective Study. J. Clin. Med. 2024, 13, 7786. [Google Scholar] [CrossRef] [PubMed]
  23. Geck, M.J.; Rinella, A.; Hawthorne, D.; Macagno, A.; Koester, L.; Sides, B.; Bridwell, K.; Lenke, L.; Shufflebarger, H. Comparison of surgical treatment in Lenke 5C adolescent idiopathic scoliosis: Anterior dual rod versus posterior pedicle fixation surgery: A comparison of two practices. Spine 2009, 34, 1942–1951. [Google Scholar] [CrossRef] [PubMed]
  24. Lonstein, J.E. Screening for spinal deformities in Minnesota schools. Clin. Orthop. Relat. Res. 1977, 126, 33–42. [Google Scholar] [CrossRef] [PubMed]
  25. Lonstein, J.E.; Bjorklund, S.; Wanninger, M.H.; Nelson, R.P. Voluntary school screening for scoliosis in Minnesota. J. Bone Jt. Surg. Am. 1982, 64, 481–488. [Google Scholar] [CrossRef] [PubMed]
  26. Winter, R.B. Scoliosis and other spinal deformities. Acta Orthop. Scand. 1975, 46, 400–424. [Google Scholar] [PubMed]
  27. Hensinger, R.; Cowell, H.R.; MacEwen, G.D.; Cronis, S. Orthopaedic screening of school age children: Review of a 10-year experience. Orthop. Rev. 1975, 4, 23–28. [Google Scholar]
  28. Grivas, T.B. School Screening in Greece, 2nd ed.; Publisher PC Paschalidis: Athens, Greece, 2000. [Google Scholar]
  29. Smyrnis, P.N.; Valavanis, J.; Alexopoulos, A.; Siderakis, G.; Gianestras, N.J. School Screening for Scoliosis in Athens. J. Bone Jt. Surg. Br. 1979, 61-B, 215–217. [Google Scholar] [CrossRef] [PubMed]
  30. Smyrnis, P.N.; Antoniou, D.; Valavanis, J.; Zachariou, C. Idiopathic scoliosis: Characteristics and epidemiology. Orthopedics 1987, 10, 921–926. [Google Scholar] [CrossRef] [PubMed]
  31. Smyrnis, P.N.; Valavanis, J.; Voutsinas, S.; Alexopoulos, A.; Ierodiaconou, M. Incidence of scoliosis in the Greek islands. In Scoliosis; Zorab, P.A., Siegler, D., Eds.; Academic Press: London, UK, 1980; pp. 13–18. [Google Scholar]
  32. Yawn, B.P.; Yawn, R.A.; Hodge, D.; Kurland, M.; Shaughnessy, W.J.; Ilstrup, D.; Jacobsen, S.J. A population-based study of school scoliosis screening. JAMA 1999, 282, 1427–1432. [Google Scholar] [CrossRef] [PubMed]
  33. Labelle, H.; Richards, S.B.; De Kleuver, M.; Grivas, T.B.; Luk, K.D.; Wong, H.K.; Thometz, J.; Beauséjour, M.; Turgeon, I.; Fong, D.Y. Screening for adolescent idiopathic scoliosis: An information statement by the scoliosis research society international task force. Scoliosis 2013, 8, 17. [Google Scholar] [CrossRef] [PubMed]
  34. Bleck, E.E. School screening for scoliosis (correspondence). Acta Orthop. Scand. 1989, 60, 123. [Google Scholar] [CrossRef]
  35. Burwell, G. The British decision and subsequent events. Spine 1988, 13, 1192–1194. [Google Scholar] [CrossRef] [PubMed]
  36. Nachemson, A. School screening for scoliosis (correspondence). Acta Orthop. Scand. 1989, 60, 124. [Google Scholar]
  37. Winter, R.B. The pendulum has swung too far: Bracing for adolescent idiopathic scoliosis in the 1990s. Orthop. Clin. N. Am. 1994, 25, 195–204. [Google Scholar] [CrossRef]
  38. Pruijs, J.E.; van der Meer, R.; Hageman, M.A.; Keessen, W.; van Wieringen, J.C. The benefits of school screening for scoliosis in the central part of The Netherlands. Eur. Spine J. 1996, 5, 374–379. [Google Scholar] [CrossRef] [PubMed]
  39. The US Preventive Services Task Force (USPSTF). U.S. Preventive Services Task Force, Screening for Idiopathic Scoliosis in Adolescents Recommendation Statement. JAMA 2018, 319, 165–172. [Google Scholar] [CrossRef]
  40. Dunn, J.; Henrikson, N.B.; Morrison, C.C.; Nguyen, M.; Blasi, P.R.; Lin, J.S. Screening for Adolescent Idiopathic Scoliosis: A Systematic Evidence Review for the U.S. Preventive Services Task Force. 2004, Rockville (MD): Agency for Healthcare Research and Quality (US); 2018 Jan. Report No.: 17-05230-EF-1.U.S. Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews. PMID: 29638297, Bookshelf ID: NBK493367. Available online: https://pubmed.ncbi.nlm.nih.gov/29638297/ (accessed on 1 March 2025). [PubMed]
  41. Linker, B. A dangerous curve: The Role of History in America’s Scoliosis Screening Programs. Am. J. Public Health 2012, 102, 606–616. [Google Scholar] [CrossRef] [PubMed]
  42. Horne, J.P.; Flannery, R.; Usman, S. Adolescent idiopathic scoliosis: Diagnosis and management. Am. Fam. Physician. 2014, 89, 193–198. [Google Scholar] [PubMed]
  43. Grossman, D.C.; Curry, S.J.; Owens, D.K.; Barry, M.J. Screening for adolescent idiopathic scoliosis: US preventive services task force recommendation statement. JAMA 2018, 319, 165–172. [Google Scholar]
  44. Available online: https://www.srs.org/Education/Manuals-and-Presentations/Braist-Presentation (accessed on 1 March 2025).
  45. Dolan, L.A.; Donnelly, M.J.; Spratt, K.F.; Weinstein, S.L. Professional opinion concerning the effectiveness of bracing relative to observation in adolescent idiopathic scoliosis. J. Pediatr. Orthop. 2007, 27, 270–276. [Google Scholar] [CrossRef]
  46. Dolan, L.A.; Sabesan, V.; Weinstein, S.L.; Spratt, K.F. Preference assessment of recruitment into a randomized trial for adolescent idiopathic scoliosis. J. Bone Jt. Surg. 2008, 90, 2594–2605. [Google Scholar] [CrossRef]
  47. Dolan, L.A.; Sabesan, V.J.; Shurr, D.G.; Weinstein, S.L. Reliability and validity of electronic temperature reading as proxy for TLSO wear time. In Proceedings of the Association of Children’s Prosthetics–Orthotics Clinics (ACPOC) Annual Meeting, Banff, AB, Canada, 24–27 March 2004. [Google Scholar]
  48. Weinstein, S.L.; Dolan, L.A.; Wright, J.G.; Dobbs, M.B. Design of the Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST). Spine 2013, 38, 1832–1841. [Google Scholar] [CrossRef] [PubMed]
  49. Weinstein, S.L.; Dolan, L.A.; Wright, J.G.; Dobbs, M.B. Effects of bracing in adolescents with idiopathic scoliosis. N. Engl. J. Med. 2013, 369, 1512–1521. [Google Scholar] [CrossRef] [PubMed]
  50. Grivas, T.B.; Hresko, M.T.; Labelle, H.; Price, N.; Kotwicki, T.; Maruyama, T. The pendulum swings back to scoliosis screening: Screening policies for early detection and treatment of idiopathic scoliosis—Current concepts and recommendations. Scoliosis 2013, 8, 16. [Google Scholar] [CrossRef] [PubMed]
  51. Plaszewskia, M.; Nowobilski, R.; Kowalski, P.; Cieslinski, M. Screening for scoliosis: Different countries’ perspectives and evidence-based health care. Int. J. Rehabil. Res. 2012, 35, 13–19. [Google Scholar] [CrossRef] [PubMed]
  52. Renshaw, T.S. Screening school children for scoliosis. Clin. Orthop. 1988, 229, 26–33. [Google Scholar] [CrossRef]
  53. Asher, M.; Beringer, G.B.; Orrick, J.; Halverhout, N. The current status of scoliosis screening in North America, 1986. Results of a survey by mailed questionnaire. Spine 1989, 14, 652–662. [Google Scholar] [CrossRef]
  54. Lonstein, J.E. Natural History and School Screening for Scoliosis. Orthop. Clin. N. Am. 1988, 19, 227–237. [Google Scholar] [CrossRef]
  55. Available online: https://www.google.com/search?q=School+Scoliosis+Screening+in+Canada (accessed on 1 March 2025).
  56. Chan, A.; Moller, J.; Vimpani, G.; Paterson, D.; Southwood, R.; Sutherland, A. The case for scoliosis screening in Australian adolescents. Med. J. Aust. 1986, 145, 379–383. [Google Scholar] [CrossRef]
  57. Mittal, R.L.; Aggerwal, R.; Sarwal, A.K. School screening for scoliosis in India.The evaluation of a scoliometer. Int. Orthop. 1987, 11, 335–338. [Google Scholar] [CrossRef]
  58. Abo-Bakr, A.; Al-Mazyiad, A.; Al-Hussein, M.; Al-Sudairy, R.; Krimli, M.; Patel, P.J. Adolescent idiopathic scoliosis screening of schoolgirls. Ann. Saudi Med. 1992, 12, 555–557. [Google Scholar] [CrossRef]
  59. Zhang, G.P.; Li, Z.R.; Wei, X.R.; Cao, Y.L.; Cui, Q.L. Screening for scoliosis among school children in Beijing. Chin. Med. J. 1988, 101, 151–154. [Google Scholar] [PubMed]
  60. Wang, Y.P.; Ye, Q.B.; Wu, B. Result on the screening of scoliosis among school students in Beijing area. Zhonghua Liu Xing Bing Xue Za Zhi 1996, 17, 160–162. (In Chinese) [Google Scholar] [PubMed]
  61. Huang, N.Q.; Guo, H.S.; Liu, J.; Huang, G.X.; Yang, X.H.; Chen, J.; Su, P.Q. A survey on adolescent scoliosis in Guangzhou. Zhonghua Liu Xing Bing Xue Za Zhi 2011, 32, 138–141. (In Chinese) [Google Scholar]
  62. Ma, X.; Zhao, B.; Lin, Q.K. Investigation on scoliosis incidence among 24,130 school children. Zhonghua Liu Xing Bing Xue Za Zhi 1995, 16, 109–110. (In Chinese) [Google Scholar]
  63. Pin, L.H.; Mo, L.Y.; Lin, L.; Hua, L.K.; Hui, H.P.; Hui, D.S.; Chang, B.D.; Chang, Y.Y.; Yuan, L. Early diagnosis of scoliosis based on school-screening. J. Bone Jt. Surg. Am. 1985, 67, 1202–1205. [Google Scholar] [CrossRef]
  64. Daruwalla, J.S.; Balasubramaniam, P.; Chay, S.O.; Rajan, U.; Lee, H.P. Idiopathic scoliosis. Prevalence and ethnic distribution in Singapore schoolchildren. J. Bone Jt. Surg. Br. 1985, 67, 182–184. [Google Scholar] [CrossRef]
  65. Sabirin, J.; Bakri, R.; Buang, S.N.; Abdullah, A.T.; Shapie, A. School scoliosis screening programme-a systematic review. Med. J. Malays. 2010, 65, 261–267. [Google Scholar]
  66. Deepak, A.S.; Ong, J.Y.; Choon, D.S.K.; Lee, C.K.; Chiu, C.K.; Chan, C.Y.W.; Kwan, M.K. The Clinical Effectiveness of School Screening Programme for Idiopathic Scoliosis in Malaysia. Malays. Orthop. J. 2017, 11, 41–46. [Google Scholar] [CrossRef]
  67. Komang-Agung, I.S.; Dwi-Purnomo, S.B.; Susilowati, A. Prevalence Rate of Adolescent Idiopathic Scoliosis: Results of School-based Screening in Surabaya, Indonesia. Malays. Orthop. J. 2017, 11, 17–22. [Google Scholar] [CrossRef] [PubMed]
  68. 2023 Tầm Soát Bàn Chân Bẹt Và Chứng Cong Vẹo Cột Sống Miễn Phí Cho Học Sinh—Free Screening for Flat Feet and Scoliosis for Students in Vietnam. Available online: https://thanhnien.vn/tam-soat-ban-chan-bet-va-chung-cong-veo-cot-song-mien-phi-cho-hoc-sinh-18523052610424714.htm (accessed on 1 March 2025).
  69. Suh, S.W.; Modi, H.N.; Yang, J.H.; Hong, J.Y. Idiopathic scoliosis in Korean schoolchildren: A prospective screening study of over 1 million children. Eur. Spine J. 2011, 20, 1087–1094. [Google Scholar] [CrossRef]
  70. Lee, J.Y.; Moon, S.H.; Kim, H.J.; Park, M.S.; Suh, B.K.; Nam, J.H.; Jung, J.K.; Lee, H.M. The prevalence of idiopathic scoliosis in eleven year-old Korean adolescents: A 3-year epidemiological study. Yonsei Med. J. 2014, 55, 773–778. [Google Scholar] [CrossRef]
  71. Ueno, M.; Takaso, M.; Nakazawa, T.; Imura, T.; Saito, W.; Shintani, R.; Uchida, K.; Fukuda, M.; Takahashi, K.; Ohtori, S.; et al. A 5-year epidemiological study on the prevalence rate of idiopathic scoliosis in Tokyo: School screening of more than 250,000 children. J. Orthop. Sci. 2011, 16, 1–6. [Google Scholar] [CrossRef]
  72. Jenyo, M.S.; Asekun-Olarinmoye, E.O. Prevalence of scoliosis in secondary school children in Osogbo, Osun State, Nigeria. Afr. J. Med. Med. Sci. 2005, 34, 361–364. [Google Scholar] [PubMed]
  73. Penha, P.J.; Penha Ramos, N.L.J.; de Carvalho, B.K.G.; Andrade, R.M.; Schmitt, A.C.B.; João, S.M.A. Prevalence of Adolescent Idiopathic Scoliosis in the State of São Paulo, Brazil. Spine 2018, 43, 1710–1718. [Google Scholar] [CrossRef] [PubMed]
  74. Nery, L.S.; Halpern, R.; Nery, P.C.; Nehme, K.P.; Stein, A.T. Prevalence of scoliosis among school students in a town in southern Brazil. Prevalência de escoliose em escolares em uma cidade do sul do Brasil. Sao Paulo Med. J. 2010, 128, 69–77. [Google Scholar] [CrossRef]
  75. Carcamo, M.; Espinoza, P.; Rodas, M.; Urrejola, O.; Bettany-Saltikov, J.; Grivas, T.B. Prevalence, risk of progression and quality of life assessment in adolescents undergoing School Screening for adolescent idiopathic scoliosis in the metropolitan region of Chile. Andes Pediatr. 2023, 94, 78–85. [Google Scholar] [CrossRef]
  76. Willner, S. A comparative study of the efficiency of different types of school screening for scoliosis. Acta Orthop. Scand. 1982, 53, 769–774. [Google Scholar] [CrossRef]
  77. Soucacos, P.N.; Soucacos, P.K.; Zacharis, K.C.; Beris, A.E.; Xenakis, T.A. School-screening for scoliosis. A prospective epidemiological study in northwestern and central Greece. J. Bone Jt. Surg. Am. 1997, 79, 1498–1503. [Google Scholar] [CrossRef]
  78. 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, 10, 527–531. [Google Scholar] [CrossRef] [PubMed]
  79. Korovessis, P.G. Observations made during school screening for scoliosis in Greece. Spine 1998, 23, 1924. [Google Scholar] [CrossRef] [PubMed]
  80. Grivas, T.B.; Koukos, K.; Koukoy, U.I.; Mazioti, C.; Polyzois, D. The incidence of idiopathic scoliosis in Greece—Analyais of domestic school screening programs. Stud. Health Technol. Inform. 2002, 91, 71–75. [Google Scholar] [PubMed]
  81. Grivas, T.B.; Samelis, P.; Polyzois, B.D.; Giourelis, B.; Polyzois, D. School screening in the heavily industrialized area--Is there any role of industrial environmental factors in idiopathic scoliosis prevalence? Stud. Health Technol. Inform. 2002, 91, 76–80. [Google Scholar] [PubMed]
  82. Gecheva-Fermendzhieva, G.Y. Comparative Analysis of The Incidence of Spinal Distortions in Adolescents for the Period 2009–2021. J. IMAB 2023, 29, 4932–4934. Available online: https://www.journal-imab-bg.org (accessed on 1 March 2025). [CrossRef]
  83. Cilli, K.; Tezeren, G.; Tas¸, T.; Bulut, O.; Oztu¨rk, H.; Oztemur, Z.; Unsaldi, T. School screening for scoliosis in Sivas, Turkey. Acta Orthop. Traumatol. Turc. 2009, 43, 426–430. [Google Scholar] [CrossRef]
  84. Ugras, A.A.; Yilmaz, M.; Sungur, I.; Kaya, I.; Koyuncu, Y.; Cetinus, M.E. Prevalence of scoliosis and cost-effectiveness of screening in schools in Turkey. J. Back. Musculoskelet. Rehabil. 2010, 23, 45–48. [Google Scholar] [CrossRef]
  85. David, R.; Jamal, A.; Soudry, M. Screening for scoliosis in western Galilee schools. Harefuah 1996, 130, 297–300, 358. (In Hebrew) [Google Scholar]
  86. Torell, G.; Nordwall, A.; Nachemson, A. The changing pattern of scoliosis treatment due to effective screening. J. Bone Jt. Surg. Am. 1981, 63, 337–341. [Google Scholar] [CrossRef]
  87. Dickson, R.A.; Leatherman, K.D. Cotrel traction, exercises, casting in the treatment of idiopathic scoliosis. A pilot study and prospective randomized controlled clinical trial. Acta Orthop. Scand. 1978, 49, 46–48. [Google Scholar] [CrossRef]
  88. Stone, B.; Beekman, C.; Hall, V.; Guess, V.; Brooks, H.L. The effect of an exercise program on change in curve in adolescents with minimal idiopathic scoliosis. A preliminary study. Phys. Ther. 1979, 59, 759–763. [Google Scholar] [CrossRef]
  89. Mollon, G.; Rodot, J.C. Scolioses structurales mineures et kinesithιrapie. Etude statistique comparative et rιsultats. Kinιsithιr Sci. 1986, 244, 47–56. [Google Scholar]
  90. Rigo, M.; Quera-Salva, G.; Puigdevall, N. Effect of the exclusive employment of physiotherapy in patients with idiopathic scoliosis. Retrospective study. In Proceedings of the 11th International Congress of the World Confederation for Physical Therapy, London, UK, 28 July–2 August 1991; pp. 1319–1321. [Google Scholar]
  91. Montgomery, F.; Willner, S. Screening for idiopathic scoliosis. Comparison of 90 cases shows less surgery by early diagnosis. Acta Orthop. Scand. 1993, 64, 456–458. [Google Scholar] [CrossRef] [PubMed]
  92. Weiss, H.R. The Schroth scoliosis-specific back school—Initial results of a prospective follow-up study. Z. Orthop. Ihre Grenzgeb. 1995, 133, 114–117. [Google Scholar] [CrossRef] [PubMed]
  93. Ferraro, C.; Masiero, S.; Venturin, A. Effect of exercise therapy on mild idiopathic scoliosis. Preliminary result. Eur. Med. Phys. 1998, 34, 25–31. [Google Scholar]
  94. Den Boer, W.A.; Anderson, P.G. Limbeek: Treatment of idiopathic scoliosis with side-shift therapy: An initial comparison with a brace treatment historical cohort. Eur. Spine J. 1999, 8, 406–410. [Google Scholar] [CrossRef]
  95. Maryama, T.; Kitagawal, T.; Takeshita, K.; Nakainura, K. Side shift exercise for idiopathic scoliosis after skeletal maturity. Stud. Health Technol. Inform. 2002, 91, 361–364. [Google Scholar]
  96. Negrini, S.; Antonini, G.; Carabalona, R.; Minozzi, S. Physical exercises as a treatment for adolescent idiopathic scoliosis. A systematic review. Pediatr. Rehabil. 2003, 6, 227–235. [Google Scholar] [CrossRef]
  97. Weiss, H.R.; Weiss, G.; Schaar, H.J. Incidence of surgery in conservatively treated patients with scoliosis. Pediatr. Rehabil. 2003, 6, 111–118. [Google Scholar] [CrossRef]
  98. Rigo, M.; Reiter, C.; Weiss, H.R. Effect of conservative management on the prevalence of surgery in patients with adolescent idiopathic scoliosis. Pediatr. Rehabil. 2003, 6, 209–214. [Google Scholar] [CrossRef]
  99. Maruyama, T.; Kitagawa, T.; Takeshita, K.; Mochizuki, K.; Nakamura, K. Con servative treatment for adolescent idiopathic scoliosis: Can it reduce the incidence of surgical treatment? Pediatr. Rehabil. 2003, 6, 215–219. [Google Scholar] [CrossRef]
  100. Otman, S.; Kose, N.; Yakut, Y. The efficacy of Schroth s 3-dimensional exercise therapy in the treatment of adolescent idiopathic scoliosis in Turkey. Saudi Med. J. 2005, 26, 1429–1435. [Google Scholar]
  101. Lenssinck, M.L.; Frijlink, A.C.; Berger, M.Y.; Bierman-Zeinstra, S.M.; Verkerk, K.; Verhagen, A.P. Effect of bracing and other conservative interventions in the treatment of idiopathic scoliosis in adolescents: A systematic review of clinical trials. Phys. Ther. 2005, 85, 1329–1339. [Google Scholar] [CrossRef] [PubMed]
  102. Beausejour, M.; Roy-Beaudry, M.; Goulet, L.; Labelle, H. Patient characteristics at the initial visit to a scoliosis clinic: A cross-sectional study in a community without school screening. Spine 2007, 32, 1349–1354. [Google Scholar] [CrossRef] [PubMed]
  103. Ohrt-Nissen, S.; Hallager, D.W.; Henriksen, J.L.; Gehrchen, M.; Dahl, B. Curve Magnitude in Patients Referred for Evaluation of Adolescent Idiopathic Scoliosis: Five Years’ Experience from a System Without School Screening. Spine Deform. 2016, 4, 120–124. [Google Scholar] [CrossRef]
  104. Adobor, R.D.; Riise, R.B.; Sørensen, R.; Kibsgård, T.J.; Steen, H.; Brox, J.I. Scoliosis detection, patient characteristics, referral patterns and treatment in the absence of a screening program in Norway. Scoliosis 2012, 7, 18. Available online: http://www.scoliosisjournal.com/content/7/1/18 (accessed on 1 March 2025). [CrossRef] [PubMed]
  105. Cho, N.I.; Hwang, C.J.; Kim, H.Y.; Baik, J.-M.; Joo, Y.S.; Lee, C.S.; Lee, M.Y.; Yoon, S.J.; Lee, D.-H. Referral patterns and patient characteristics at the first visit to a scoliosis center: A 2-year experience in South Korea without a school scoliosis-screening program. J. Neurosurg. Pediatr. 2018, 21, 414–420. [Google Scholar] [CrossRef]
  106. Grivas, T.B.; Vasiliadis, E.S.; Mihas, C.; Savvidou, O. The effect of growth on the correlation between the spinal and rib cage deformity: Implications on idiopathic scoliosis pathogenesis. Scoliosis 2007, 2, 11. [Google Scholar] [CrossRef]
  107. Grivas, T.B.; Daggas, S.; Polyzois, B.; Samelis, P. The double rib contour sign in lateral spinal radiographs. Aetiologic implications for scoliosis. Stud. Health Technol. Inform. 2002, 88, 38–43. [Google Scholar] [PubMed]
  108. Nissinen, M.; Heliövaara, M.; Seitsamo, J.; Poussa, M. Trunk asymmetry, posture, growth, and risk of scoliosis. A three-year follow-up of Finnish prepubertal school children. Spine 1993, 18, 8–13. [Google Scholar] [CrossRef]
  109. Grivas, T.B.; Vasiliadis, E.; Savvidou, O.D.; Triantafyllopoulos, G. What a school screening program could contribute in clinical research of idiopathic scoliosis aetiology. Disabil. Rehabil. 2008, 30, 752–762. [Google Scholar] [CrossRef]
  110. Grivas, T.B. Rib Index. Scoliosis 2014, 9, 20. Available online: https://scoliosisjournal.biomedcentral.com/articles/10.1186/s13013-014-0020-9 (accessed on 1 March 2025). [CrossRef] [PubMed]
  111. Huang, S.C. Cut-off point of the Scoliometer in school scoliosis screenin. Spine 1997, 22, 1985–1989. [Google Scholar] [CrossRef] [PubMed]
  112. Karachalios, T.; Sofianos, J.; Roidis, N.; Sapkas, G.; Korres, D.; Nikolopoulos, K. Ten-year follow-up evaluation of a school screening program for scoliosis. Is the forward-bending test an accurate diagnostic criterion for the screening of scoliosis? Spine 1999, 24, 2318–2324. [Google Scholar] [CrossRef] [PubMed]
  113. Grivas, T.B.; Savvidou, O. Melatonin the “light of night” in human biology and adolescent idiopathic scoliosis. Scoliosis 2007, 2, 6. [Google Scholar] [CrossRef]
  114. Reiter, R.J. The pineal and its hormones in the control of reproduction in mammals. Endocr. Rev. 1980, 1, 109–131. [Google Scholar] [CrossRef]
  115. Batrinos, M.L. Endocrinology; Medical Publications, P. Paschalidis Publisher: Athens, Greece, 1995; pp. 111–115. [Google Scholar]
  116. Segos, C. Puberty. In Honorary Volume; Aravantinos, D.J., Michalas, S.P., Goumalatsios, N.G., Eds.; Parisianos Publisher: Athens, Greece, 1999; pp. 629–633. [Google Scholar]
  117. Brzezinski, A. Melatonin in humans. N. Engl. J. Med. 1997, 336, 186–194. [Google Scholar] [CrossRef]
  118. Rosenberg, M. Menarheal age for Norwegian women born 1830–1960. Ann. Hum. Biol 1991, 18, 207–219. [Google Scholar] [CrossRef] [PubMed]
  119. Dossus, L.; Kvaskoff, M.; Bijon, A.; Engel, P.; Verdebout, J.; Fervers, B.; Boutron-Ruault, M.-C.; Clavel-Chapelon, F.; Mesrine, S. Latitude and ultraviolet radiation dose in the birthplace in relation to menarcheal age in a large cohort of French women. Int. J. Epidemiol. 2013, 42, 590–600. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
  120. Pjanic, S.; Jevtic, N.; Grivas, T.B. Menarche in Scoliotic and Non-Scoliotic Balkan Girls and the Relationship between Menarche and the Laterality of Scoliotic Curves. J. Clin. Med. 2023, 13, 132. [Google Scholar] [CrossRef] [PubMed]
  121. Grivas, T.B.; Savvidou, O.D.; Vasiliadis, E.; Psarakis, S.; Koufopoulos, G. Prevalence of scoliosis in women with visual deficiency. Stud. Health Technol. Inform. 2006, 123, 52–56. [Google Scholar] [PubMed]
  122. Hawes, M.C. The use of exercises in the treatment of scoliosis: An evidence-based critical review of the literature. Pediatr. Rehabil. 2003, 6, 171–182. [Google Scholar] [CrossRef]
  123. Shands, A.R.; Barr, J.S.; Collona, P.C.; Noall, L. End-result study of the treatment of idiopathic scoliosis. Report of the Research Committee of the American Orthopaedic Association. J. Bone Jt. Surg. Am. 1941, 23, 963–977. [Google Scholar]
  124. Weiss, H.R.; Negrini, S.; Hawes, M.C.; Rigo, M.; Kotwicki, T.; Grivas, T.B.; Maruyama, T. Physical exercises in the treatment of idiopathic scoliosis at risk of brace treatment—SOSORT consensus paper 2005. Scoliosis 2006, 1, 6. [Google Scholar] [CrossRef] [PubMed]
  125. Weiss, H.R.; Weiss, G.; Petermann, F. Incidence of curvature progression in idiopathic scoliosis patients treated with scoliosis in-patient rehabilitation (SIR): An age- and sex-matched controlled study. Pediatr. Rehabil. 2003, 6, 23–30. [Google Scholar] [CrossRef]
  126. Asher, M.A.; Burton, D.C. Adolescent idiopathic scoliosis: Natural history and long-term treatment effects. Scoliosis 2006, 1, 2. [Google Scholar] [CrossRef]
  127. Grivas, T.B.; Vasiliadis, E.; Chatziargiropoulos, T.; Polyzois, V.D.; Gatos, K. The effect of a modified Boston brace with anti-rotatory blades on the progression of curves in idiopathic scoliosis: Aetiologic implications. Pediatr. Rehabil. 2003, 6, 237–242. [Google Scholar] [CrossRef] [PubMed]
  128. Korovessis, P.; Kyrkos, C.; Piperos, G.; Soucacos, P.N. Effects of thoracolumbosacral orthosis on spinal deformities, trunk asymmetry, and frontal lower rib cage in adolescent idiopathic scoliosis. Spine 2000, 25, 2064–2071. [Google Scholar] [CrossRef]
  129. Nachemson, A.L.; Peterson, L.E. Effectiveness of treatment with a brace in girls who have adolescent idiopathic scoliosis. A prospective, controlled study based on data from the Brace Study of the Scoliosis Research Society. J. Bone Jt. Surg. Am. 1995, 77, 815–822. [Google Scholar] [CrossRef]
  130. Rowe, D.E.; Bernstein, S.M.; Riddick, M.F.; Adler, F.; Emans, J.B.; Gardner-Bonneau, D. A meta-analysis of the efficacy of non-operative treatments for idiopathic scoliosis. J. Bone Jt. Surg. Am. 1997, 79, 664–674. [Google Scholar] [CrossRef]
  131. Valavanis, J.; Bountis, A.; Zachariou, C.; Kokkonis, D.; Anagnostou, D.; Giahos, D.; Daskalakis, E. Three-dimensional brace treatment for idiopathic scoliosis. In Three-Dimensional Analysis of Spinal Deformities D’Amico; IOS Press: Amsterdam, The Netherlands, 1995; pp. 337–340. [Google Scholar]
  132. Catanzariti, J.F.; Moretto, F.; Hanot, Q.; Adam, C.; Renaud, G.; Brouillard, A. Benefits of Intensive Rehabilitation Programs Using Physiotherapeutic Scoliosis-Specific Exercises in Adolescent Idiopathic Scoliosis. Cureus. 2024, 16, e76359. [Google Scholar] [CrossRef] [PubMed]
  133. Angelliaume, A.; Pfirrmann, C.; Alhada, T.; Sales de Gauzy, J. Non-operative treatment of adolescent idiopathic scoliosis. Orthop. Traumatol. Surg. Res. 2024, 111, 104078. [Google Scholar] [CrossRef] [PubMed]
  134. Monticone, M.; Ambrosini, E.; Cazzaniga, D.; Rocca, B.; Ferrante, S. Active self-correction and task-oriented exercises reduce spinal deformity and improve quality of life in subjects with mild adolescent idiopathic scoliosis. Results of a randomised controlled trial. Eur. Spine J. 2014, 23, 1204–1214. [Google Scholar] [CrossRef] [PubMed]
  135. Tones, M.; Moss, N.; Polly, D.W., Jr. A review of quality of life and psychosocial issues in scoliosis. Spine 2006, 31, 3027–3038. [Google Scholar] [CrossRef] [PubMed]
Healthcare 13 00600 g001
Figure 1. EM. N. LAMPADARIOS SCOLIOSIS. THE DISEASES OF SCHOOL. IN ATHENS. From the printing house of Thanos Tzavellas, 1 Aristidou Street, 1915. — EM. N. ΛAMΠAΔAPIOΣ H ΣKOΛIΩΣIΣ. TA NOΣHMATA TOΥ ΣXOΛEIOΥ. EN AΘHNAIΣ. Eκ του τυπογραφείου Θάνου Tζαβέλλα, Eν οδώ Aριστείδου 1, 1915.
Figure 1. EM. N. LAMPADARIOS SCOLIOSIS. THE DISEASES OF SCHOOL. IN ATHENS. From the printing house of Thanos Tzavellas, 1 Aristidou Street, 1915. — EM. N. ΛAMΠAΔAPIOΣ H ΣKOΛIΩΣIΣ. TA NOΣHMATA TOΥ ΣXOΛEIOΥ. EN AΘHNAIΣ. Eκ του τυπογραφείου Θάνου Tζαβέλλα, Eν οδώ Aριστείδου 1, 1915.
Healthcare 13 00600 g001
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Grivas, T.B.; 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 2025, 13, 600. https://doi.org/10.3390/healthcare13060600

AMA Style

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. 2025; 13(6):600. https://doi.org/10.3390/healthcare13060600

Chicago/Turabian Style

Grivas, Theodoros B., Elias Vasiliadis, Christina Mazioti, Aristea Mamzeri, Despina Papagianni, Galateia Katzouraki, and Nikolaos Sekouris. 2025. "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 13, no. 6: 600. https://doi.org/10.3390/healthcare13060600

APA Style

Grivas, T. B., Vasiliadis, E., Mazioti, C., Mamzeri, A., Papagianni, D., Katzouraki, G., & Sekouris, N. (2025). 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, 13(6), 600. https://doi.org/10.3390/healthcare13060600

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop