 Aug 24, 2015 / Scoliosis & Spine
After summer break, many kids will be screened for scoliosis. Here is some information that you should know about the process:
Watch this video from our Assistant Chief of Staff Dr. Karl Rathjen. Tags:1. US Preventive Services TaskForce, Recommendation Statement: Screening for Idiopathic Scoliosis in Adolescents (AHRQ Pub. No. 05-0568-A. November 2004), accessed February 18, 2011, http://www.uspreventiveservicestaskforce.org/3rduspstf/scoliosis/scoliors.pdf. For more on the establishment of the US Preventive Services Task Force (USPSTF), see Steven H. Woolf, Carolyn G. DiGuiseppi, David Atkins, and Douglas B. Kamerow, “Developing Evidence-Based Clinical Practice Guidelines: Lessons Learned by the U.S. Preventative Task Force,” Annual Reviews of Public Health 17 (1996): 511–38. The US Public Health Service established the USPSTF in 1984. The USPSTF is a nongovernmental expert panel that reviews evidence regarding the effectiveness of clinical preventive services and makes recommendations for health professionals regarding which preventive services to include in the periodic health examination. 2. Even when examiners used a scoliometer, a device that results in fewer false-positive results than the forward-bending test, researchers still found significant interreader errors. See Thomas W. Grossman, John M. Mazur, and R. Jay Cummings, “An Evaluation of the Adams Forward Bend Test and the Scoliometer in a Scoliosis School Screening Setting,” Journal of Pediatric Orthopedics 15 (1995): 535–8. See also George A. C. Murrell, Ralph W. Coonrad, Claude T. Moorman, and Robert D. Fitch, “An Assessment of the Reliability of the Scoliometer,” Spine 18 (1993): 709–12. 3. US Preventative Services Task Force, “Screening for Idiopathic Scoliosis in Adolescents: Recommendation Statement,” accessed February 12, 2011, http://www.uspreventiveservicestaskforce.org/3rduspstf/scoliosis/scoliors.htm. 4. For Great Britain and Australia, see Theodoros B. Grivas, Marian H. Wade, Stefano Negrini, Joseph P. O'Brien, Toru Maruyama, Martha C. Hawes, Manuel Rigo, Hans Rudolf Weiss, Tomasz Kotwicki, Elias S. Vasiliadis, Lior Neuhaus Sulam, and Tamar Neuhous, “SOSORT Consensus Paper: School Screening for Scoliosis: Where Are We Today?,” Scoliosis 2 (2007): 1–23. For Canada, see Marie Beauséjour, Marjolaine Roy-Beaudry, Lise Goulet, and Hubert Labelle, “Patient Characteristics at the Initial Visit to a Scoliosis Clinic: A Cross-Sectional Study in a Community Without School Screening,” Spine 32 (2007): 1349–54. 5. Twenty-one states mandate it through law, and twelve additional states recommend screening. See Grivas, “SOSORT Consensus Paper,” 2. 6. Han Jo Kim, John S. Blanco, and Roger F. Widmann, “Update on the Management of Idiopathic Scoliosis,” Current Opinion in Pediatrics 21 (2009): 55–64. See also See also John H. Moe and John E. Lonstein, Moe's Textbook of Scoliosis and Other Spinal Deformities, 3rd ed. (Philadelphia: WB Saunders, 1995) 7. For Iowa results, see Stuart Weinstein, Lori A. Dolan, Kevin F. Spratt, Kirk K. Peterson, Mark J. Spoonamore, and gnacio V. Ponseti, “Health and Function of Patients With Untreated Idiopathic Scoliosis: A 50-Year Natural History Study,” Journal of the American Medical Association 289 (2003): 559–67. [PubMed] 8. For more on the history of posture in America, see David Yosifon and Peter N. Stearns, “The Rise and Fall of American Posture,” The American Historical Review 103 (1998): 1057–95. [PubMed] 9. David J Rothman, Beginnings Count: The Technological Imperative in American Health Care (New York: Oxford University Press, 1997) 10. Sohrabi Louise F, The Crooked Journey: The Story of a Woman's Fight Against Scoliosis (Alameda, Calif: Rima Press, 1983). [Google Scholar] 11. For a discussion of the principles of screening, see 11. As of 2000, Barbara and Roy Yawn estimated that screening could cost as “little as $0.06 to as much as $194 per child… with the higher estimate defined as all children with curves of 5 degrees or more.” Barbara P. Yawn and Roy A. Yawn, “The Estimated Cost of School Scoliosis Screening,” Spine 25 (2000): 2387–91. Grant Higginson, “Political Considerations for Changing Medical Screening Programs,” Journal of the American Medical Association 282(1999): 1472–4. 12. A more thorough account of this history can be found in Richard Meckel, “Going to School, Getting Sick: The Social and Medical Construction of School Diseases in the Late Nineteenth Century,” in Formative Years: Children's Health in the United States, 1880–2000, ed. Alexandra M. Stern and Howard Markel. (Ann Arbor: University of Michigan Press, 2002), 185 –207. 13. “Physical Examination of School Children,” Boston Medical and Surgical Journal 152 (1905): 587. 14. For more on the history of such “defects,” see George T. Stafford, “First Problem in Education to Prevent or Correct Physical Defects,” School Life 10 (1925): 114 –5. Beth Linker, “Feet for Fighting: Locating Disability and Social Medicine in World War I America,” Social History of Medicine 20(2007): 91 –109. 15. US Children's Bureau, Posture Exercises: A Handbook for Schools and for Teachers of Physical Education (Washington, DC: US Department of Labor, 1926). Dr. Armin Klein, director of a posture clinic at the Massachusetts General Hospital, and Leah C. Thomas, director of corrective gymnastics at Smith College, served as the key researchers for this educational initiative. 16. Lovett Robert W, Lateral Curvature of the Spine and Round Shoulders (Philadelphia: P. Blakiston's & Company, 1907). [Google Scholar] 17. Goldthwait Joel E., “The Relation of Posture to Human Efficiency and the Influence of Poise Upon the Support and Function of the Viscera” (paper read at a meeting of the Boston Medical Library held in conjunction with the Suffolk District Medical Society, Boston, MA, December 2, 1908). Joel E. Goldthwait, “An Anatomic and Mechanistic Conception of Disease,” Boston Medical and Surgical Journal 172(1915): 881 –98. See also Joel E. Goldthwait, Body Mechanics in the Study and Treatment of Disease (Philadelphia: J. B. Lippincott Company, 1934) 18. Goldthwait was not alone in his belief that one's constitution determined one's health. See Sarah W. Tracy, “George Draper and American Constitutional Medicine, 1916-1946: Reinventing the Sick Man,” Bulletin of the History of Medicine 66 (1992): 53 –89. [PubMed] 19. Irving Fisher and Eugene Lyman Fisk, How to Live: Rules for Healthful Living, Based on Modern Science (New York: Funk & Wagnalls Company, 1915). See also Laura D. Hirschbein, “Masculinity, Work and the Foundation of Youth: Irving Fisher and the Life Extension Institute, 1914-1931,” Canadian Bulletin of Medicine 16 (1999): 89–124. 20. Bancroft Jessie H, The Posture of School Children: With Its Home Hygiene and New Efficiency Methods for School Training (New York: The Macmillan Company, 1913), 1 [Google Scholar] 21. Office of General the Surgeon, Defects Found in Drafted Men (Washington, DC: Government Printing Office, 1920). See also Beth Linker, War's Waste: Rehabilitation in World War I America (Chicago: University of Chicago Press, 2011) 22. US Public Health Service, Flat Foot and Other Troubles (Washington, DC: Government Printing Office, 1920). Louis Schwartz, Studies in Physical Development and Posture: Postural Relations as Noted in Twenty-Two Hundred Boys and Men (Bulletin of the U.S. Public Health Service 199) (Washington, DC: Government Printing Office, 1931). US Department of Labor, Posture Exercises: A Handbook for Schools and for Teachers of Physical Education (Washington, DC: Government Printing Office, 1926). White House Conference on Child Health and Protection, Body Mechanics: Education and Practice; Report of the Subcommittee on Orthopedics and Body Mechanics (New York: Century Company, 1932). US Department of Labor IChildren's Bureau, Good Posture in the Little Child (Washington, DC: Government Printing Office, 1933). US Department of Labor, Posture Clinics: Organization and Exercises (Washington, DC: Government Printing Office, 1926). Margaret T. Mettert, Women's Effective War Work Requires Good Posture (Special Bulletin of the US Women's Bureau 10) (Washington, DC: Government Printing Office, 1943) 23. Stafford, “First Problem,” (1925) 24. For more on the history of children's health, see Janet L. Golden, Richard A. Meckel, and Heather Munro Prescott, Children and Youth in Sickness and in Health: A Historical Handbook and Guide (Westport, Conn: Greenwood Press, 2004) and Stern and Markel, Formative Years. 25. The method for evaluating posture varied from school to school and largely depended on the examiner's preference, comfort with various technologies, and constraints of space and time. One popular posture-measuring device in the early decades of the 20th century was the schematograph, an instrument codeveloped by Stanford University professors Dr. Clelia D. Mosher (better known among today's scholars for her sex studies) and Everett Parker Lesley (a mechanical engineer who would go on to design airplane propellers for the National Advisory Committee on Aeronautics during the interwar years). Using the technology of a clear glass reflecting camera along with tracing paper, an examiner could trace a full-body silhouette of an unclad school student. Mosher preferred her device over photography because it preserved a student's anonymity and dignity—she made plain her worries that photographs of individual students could fall into the wrong hands, and confidentiality between doctor and patient-student would be breeched. Clelia Duel Mosher, “The Schematogram: A New Method of Graphically Recording Posture and Changes in the Contours of the Body,” School and Society 1(1915): 642 –5. Mosher was prescient about what would happen if school examiners began to rely solely on photography. See Ron Rosenbaum, “The Great Ivy League Nude Posture Photo Scandal,” New York Times Magazine, January 15, 1995, SM26 –30, 40 –1, 46, 55 –6. 26. Bancroft, The Posture of School Children. 27. For a sampling, see Ethel M. Hendriksen, “Posture Work for Preschool Children,” Hygeia 4 (February 1926): 76 –8; “Good Posture as an Aid to Beauty,” Hygeia 4 (July 1926): 399 –400; Phillip P. Lewin, “Ten Commandments of Good Posture,” Hygeia 6 (January 1928): 3 –5; “Flower Garden: A Posture Play Adapted for Kindergarten and First Grade Pupils,” Hygeia 7 (July 1929): 728; “Kin Arthur Posture Play,” Hygeia 7 (August 1929): 826 –7; Lillian C. Drew, “Ode to Posture,” Hygeia 13 (March 1935): 224; Henry Eastman Bennett, “Toward an Upsitting Generation,” Hygeia 13 (September 1935): 836 –9; Frank H. Krusen, “Willie, Pull Your Stomach In!,” Hygeia 14 (November 1936): 970 –2; Mae Kelly, “Cutting a Fashionable Figure,” Hygeia 17 (March 1939): 212 –5. 28. Mosher, “The Schematogram,” 642. 29. For a sampling, see 29. Dr. Florence Richards, “Desk Exercises for Business Girls,” Ladies Home Journal, March 1913, 72; Dr. Alan DeForest Smith, “Correct Posture for Children,” The Delineator, February 1922, 46; Donald A Laird, “There Is a Lot to Just Sitting and Standing,” Scientific American 104 (November 1928): 402 –4; Nora Mullane, “Physical Exercise, Moderate Eating, and a Correct Posture Prevents Obesity,” Good Housekeeping, March 1922, 82; Anna H. Delavan, “To Sit Correctly With Dignity,” Good Housekeeping, January 1925, 92; Marie Beynon Ray, “Cutting a Fine Figure,” Collier's, August 18, 1934, 21, 80. 30. Yosifon and Stearns, “American Posture.”. 31. For more on the history of the pharmacological revolution, see Dominque Tobbell, Pills, Power, and Policy: The Struggle for Drug Reform in Cold War America and Its Consequences (Berkeley: University of California Press, 2012); Robert Bud, Penicillin: Triumph and Tragedy (Oxford, UK: Oxford University Press, 2007); Andrea Tone and Elizabeth Siegel Watkins, eds., Medicating Modern America: Prescription Drugs in History (New York: New York University Press, 2007) 32. A. R. Shands Jr. and Harry B. Eisberg, “The Incidence of Scoliosis in the State of Delaware: A Study of 50,000 Minifilms of the Chest Made During a Survey for Tuberculosis,” Journal of Bone and Joint Surgery 37 (1955): 1243 –9. [PubMed] 33. For more on medical definitions and treatment of adolescence, see The age range for teenage in this study was ages 15 –19. Heather Munro Prescott, A Doctor of Their Own: The History of Adolescent Medicine (Cambridge, Mass: Harvard University Press, 1998) 34. Samuel Cronis and A.Yvonne Russell, “Orthopedic Screening of Children in Delaware Public Schools,” Delaware Medical Journal 37 (1965): 89 –92. [PubMed] 35. For an example of this usage, see Walter P. Blount and John H. Moe, The Milwaukee Brace, 1st ed. (Baltimore, Md: Williams and Wilkins Company, 1973), vii. 36. Risser Joseph C, “Scoliosis: Past and Present,” Journal of Bone and Joint Surgery 46 (1964): 167–99 [PubMed] [Google Scholar] 37. See Robert A. Aronowitz, “Do Not Delay: Breast Cancer and Time, 1900-1970,” Milbank Quarterly 79 (2001): 355 –86 and Robert A. Aronowitz, Unnatural History: Breast Cancer and American Society (New York: Cambridge University Press, 2007). See also Barron Lerner, The Breast Cancer Wars: Hope, Fear, and the Pursuit of a Cure in Twentieth-Century America (New York: Oxford University Press, 2001) and Ilana Löwy, Prevention Strikes: Women, Precancer, and Prophylactic Surgery (Baltimore, Md: Johns Hopkins University Press, 2010) 38. Collis Dennis K, Ponseti Ignacio V, “Long-Term Follow-Up of Patients With Idiopathic Scoliosis Not Treated Surgically,” Journal of Bone and Joint Surgery 51 (1969): 425 –45 [PubMed] [Google Scholar] 39. Collis and Ponseti, “Idiopathic Scoliosis Not Treated Surgically,” 444. [PubMed] 40. Winter Robert B, Kane William J, “John H. Moe: In Memoriam,” Spine 13 (1988): 442 [Google Scholar] 41. Moe John H, “Correspondence: Postural Scoliosis,” British Medical Journal 2 (1965): 1431 –2 [Google Scholar] 42. Harrington Paul R, “Treatment of Scoliosis: Correction and Internal Fixation by Spine Instrumentation,” Journal of Bone and Joint Surgery 44 (1962): 591–611 [PubMed] [Google Scholar] 43. Moe John H., Kettleson David K., “Idiopathic Scoliosis,” Journal of Bone and Joint Surgery 52 (1970): 1509 –33. Moe evaluated 169 patients from his private practice who had adolescent idiopathic scoliosis and who had worn a Milwaukee brace for at least 12 months. He estimated that at least 33 of these patients showed “poor cooperation” in their brace wear, so he removed them from the study. To better convey his results, he broke down the study group into types of curvatures: high thoracic (HT), thoracic (T), and lumbar (L). After brace wear, curves of HT patients ranged from as much as 5 percent worse to 30 percent improvement. T patients saw a median correction of 23 percent, with a range of –10 to 80 percent. L patients had a median improvement of 18 percent, with a range of 0 to 100 percent 44. Behrooz A. Akbarnia, “Embracing Opportunities in Exciting Times: 2006 SRS Presidential Address,” Spine 32 (2007): 2153–7. Scoliosis screening should be understood within the larger story of medical surveillance. Beginning with tuberculosis screening early in the 20th century, to Papanicolaou tests, mammograms, and detecting phenylketonuria in neonatology, medical practice has increasingly moved toward ever-greater screening as a form of preventive health care. Diane Paul, “Contesting Consent: The Challenge to Compulsory Neonatal Screening for PKU,” Perspectives in Biology and Medicine 42(1999): 207–19; Barron H. Lerner, “‘To See Today With the Eyes of Tomorrow’: A History of Screening Mammography,” Canadian Bulletin of Medical History 20 (2003): 299–321; Monica J. Casper and Adele E. Clarke, “Making the Pap Smear Into the ‘Right Tool’ for the Job: Cervical Cancer Screening in the USA, Circa 1940-95,” Social Studies of Science 28 (1998): 255–90; and Alan Derickson, “‘On the Dump Heap’: Employee Medical Screening in the Tri-State Zinc-Lead Industry, 1924-1932,” The Business History Review 62 (1988): 656–77. 45. Aronowitz makes the same argument about the use of fear in raising breast cancer screening awareness. See “Do Not Delay,” 357–9. 46. Winter Robert B, Moe John H, “A Plea for the Routine School Examination of Children for Spinal Deformity,” Minnesota Medicine 57 (1974): 419–24 [PubMed] [Google Scholar] 47. Lonstein John E, Winter Robert B, Moe John H, Bianco Anthony J, Campbell Ronald G, Norval Mildred A, “School Screening for the Early Detection of Spine Deformities: Progress and Pitfalls,” Minnesota Medicine 59 (1976): 51–7 [PubMed] [Google Scholar] 48. Walter P. Blount and John H. Moe, The Milwaukee Brace (Baltimore, Md: Williams and Wilkins Company, 1973) 49. Moe blamed certain cases of ill-fitting braces on “zealous parents” who took it upon themselves to adjust their child's brace in between office visits. As of 1973, parents were “forbidden to adjust the braces, except under the direction of an orthopedic surgeon.” Blount and Moe, The Milwaukee Brace, 6. 50. Rosalie Griesse, The Crooked Shall Be Made Straight (Atlanta, Ga: John Knox Press, 1979), 45. 51. Blount and Moe, The Milwaukee Brace, x. Emphasis added. 52. Marie Balzer, Scoliosis: An Annotated Bibliography (Raleigh, NC: The Scoliosis Association, 1989), back plate. 53. Grivas, “SOSORT Consensus Paper.” How screening became legislated—and to what end it served—differed state by state. Some states mandated screening by amending their educational codes, whereas others created legislation through their departments of health. The rationale for screening also varied, but most states agreed that the chief goal was to “ensure that all children and youth… [would] have a normal development and a normal life.” See California State Department of Education, Standards for Scoliosis Screening (Sacramento: State of California, 1985), 1. See also Missouri Bureau of Maternal and Child Health, Screening Guide for Use in Missouri Schools (Jefferson City: State of Missouri, 1979) 54. See, for example, “Spines of Steel,” Time, November 14, 1960, 56; “A Dangerous Curve,” Time, February 24, 1975, 66–7; Dr. Cory Servess, “Medical Mailbox,” The Saturday Evening Post, December 1975, 72–3; Carrie Holtman, “Braced for the Best,” Seventeen, May 1977, 36; Michael P. Scott, “A Simple Test for Scoliosis,” Better Homes and Gardens, August 1977, 71–2; Robert J. Trotter, “Preventing the Curve,” Science News, May 1979, 298–302; Matt Clark and Dan Shapiro, “Righting the Spine,” Newsweek, November 26, 1979, 94; Ralph Schoenstein, “I Fell Out of a Plane but Everything's OK Now,” Today's Health, November 1973, 50–3; and Maria Cerniello, “Children's Back Troubles: Catching Them Early,” McCall's, July 1981, 40. 55. Judy Blume, Deenie (Scarsdale, NY: Bradbury Press, 1973) 56. Wallace Asha, “A Scoliosis Screening Program,” Journal of School Health 47 (1977): 619–20 [PubMed] [Google Scholar] 57. Michael Warren, Jane Leaver, and Anne Alvik, “Letters to the Editor: School Screening for Scoliosis,” The Lancet 2 (1981): 522. Calling for more scientific, population-based research, Warren argued that “We do not know the natural history of scoliosis—that is, the causes of adolescent idiopathic scoliosis and the determinants of its progression....Epidemiologists emphasize that studies of the natural history of the disease must be based on all cases (mild and severe) arising in a defined population and cannot be limited to severe cases seen in special clinics” (522) 58. Wynne Elizabeth J, “Scoliosis: To Screen or Not to Screen,” Canadian Journal of Public Health 75 (1984): 277–80 [PubMed] [Google Scholar] 59. Berwick Donald M, “Scoliosis Screening: A Pause in the Chase,” American Journal of Public Health 75 (1985): 1373–4 [PMC free article] [PubMed] [Google Scholar] 60. For more recent findings from the University of Iowa, see 60. The first of these arguments can be found in the 1960s. See, for example, J. I. P. James, “Postural Scoliosis," The British Medical Journal 1 (1966): 46. The Department of Orthopedic Surgery at the University of Iowa carried out its longitudinal study throughout the remainder of the 20th century and continued to voice doubts about the findings of Moe, Winter, and Lonstein. See “Correspondence,” Journal of Bone and Joint Surgery 79(1997): 954–55. Stuart L. Weinstein, Lori A. Dolan, Jack C. Y. Cheng, Aina Danielsson, and Jose A. Morcuende, “Adolescent Idiopathic Scoliosis,” The Lancet 371 (2008): 1527–37 and Stuart L. Weinstein, Lori A. Dolan, Kevin F. Spratt, Kirk K. Peterson, Mark J. Spoonamore, and Ignacio V. Ponseti, “Health and Function of Patients With Untreated Idiopathic Scoliosis: A 50-Year Natural History Study,” Journal of the American Medical Association 289 (2003): 559–67. 61. Moe, “Correspondence,” 1432. One 1995 study concluded that 60 percent of patients treated with bracing “felt that [it] handicapped their life,” and 14 percent believed that it “left a psychological scar.” A. L. Nachemson and L. E. Peterson, “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,” Journal of Bone and Joint Surgery. 22 (1995): 815–22. [PubMed] 62. Penny Hatcher, Adolescent School Screening for Scoliosis in Minnesota (Minneapolis: Minnesota Department of Health, 2008), 13. 63. Grivas, et al., “SOSORT Consensus Paper,” 3. 64. 64.Ibid. 65. See, for example, Dr. Robert Winter's response to the first US Preventive Services Task Force report expressing concerns about the effectiveness of scoliosis screening. Robert Winter, “Screening for Scoliosis,” Journal of the American Medical Association 273 (1995): 185–6. See also B. Stephens Richards and Michael G. Vitale, “Screening for Idiopathic Scoliosis in Adolescents: An Information Statement,” Journal of Bone and Joint Surgery 90 (2008): 195–8. 66. Cross Alan W, “Health Screening in Schools, Part II,” The Journal of Pediatrics 107 (1985): 653–61 [PubMed] [Google Scholar] 67. Ibid. |
What is the school nurses explanation as to the purpose of scoliosis screening in this population
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