Scoliosis Screenings at School

School nurses are an important link in identifying scoliosis in adolescents. During school scoliosis screenings, school nurses are the first to identify that an adolescent may have the signs of scoliosis. School nurses may be interested in the following facts:

• In 80 percent to 85 percent of adolescent scoliosis cases, the cause is unknown (called idiopathic scoliosis).
  
• Girls are at least four times more likely than boys to develop scoliosis.
  
• Most scoliosis develops gradually between the ages of 10 and 16, and usually parents and friends do not notice the gradual changes.
  
• Scoliosis is more likely to progress with the growth spurt during puberty.
  
• Scoliosis tends to run in families. If the child has a family history of scoliosis, they are more at risk to develop it and should be screened every six months.
  
• Scoliosis is usually painless in adolescents.

Scoliosis is usually discovered during a routine medical exam, school screening, sports physical or when the adolescent puts on a swimsuit at the start of summer.

During a school screening, it is important to have the child remove any bulky sweaters or sweat shirts and just take a good look at their back. School nurses should look for the following signs of scoliosis:

• uneven shoulders or waistline
  
• one or both shoulder blades sticking out
  
• leaning slightly to one side
  
• hump on one side of the back

Have the children turn so that their back is to the screener.With chin on their chest, arms stretched out in front of them and palms together, the children should slowly bend over and touch their feet while keeping their legs straight. This maneuver often will make a slight asymmetry easier to spot.

If scoliosis is suspected, it is important to have the adolescent evaluated further by either their family doctor or a spine expert. Cleveland Clinic adolescent spine experts offer a thorough evaluation, which includes: medical and family history; physical exam; neurological exam; and X-rays to pinpoint the location, extent and degree of the curve, alignment of the hip and pelvic bones, and the amount of spinal growth remaining. It is vital to assess skeletal maturity, because scoliosis tends to progress during spinal growth.

Early detection is paramount in being able to treat scoliosis conservatively. If an adolescent presents with a curvature that is less than 20 degrees, typically the spine expert will follow the patient with spine films every four to six months to monitor the curve for signs of progression. If the adolescent presents with a curve of greater than 20 degrees but less than 40 degrees and still has skeletal growth remaining, he or she most likely will be placed in a bending brace that is worn only at night. The goal of bracing is not correction of the curve but rather to halt the progression. Once the child is placed in the brace, he or she will have an appointment with an X-ray in the brace to confirm brace efficacy and fit. The spine expert will follow the adolescent every four to six months with Xrays to confirm the cessation of curve progression. If the adolescent presents with a curvature greater than 40 to 45 degrees or has failed bracing and progresses to 40 to 45 degrees, the only other treatment is surgical correction.

The goal of surgery is to make the spine straighter, usually by 40 percent to 80 percent, and to fuse the spine to hold the correction and prevent further progression. The surgeon fuses the vertebrae together through bone graft and uses metallic implants to hold the spine until fusion takes place, so there is no need for bracing after surgery in most cases. Usually eight to 12 months are required for the fusion to be solid enough for the adolescent to return to all activities with the exception of collision sports.

Ninety-nine percent of adolescents with scoliosis continue to participate in sports, dance and similar physical activities. Spine experts at The Cleveland Clinic emphasize the importance of staying fit and active. The school nurse can play a vital role in reassuring adolescents that a mild, stable curve may never need treatment and generally will only require semi-annual checkups. It is reassuring to note that of the 2 percent to 3 percent of American 16-year-olds that have scoliosis, only 0.1 percent ever develop curves severe enough to warrant surgery.

Scoliosis is best treated by a professional team, and the school nurse often is the first link in the identification and treatment of scoliosis.