Wednesday, July 4, 2012

The Future of Scoliosis Screening


Fig 1. An X-ray (posteroanterior) of a patient
with scoliosis typically displays an S- or C- 
shaped, side-to-side curve rather than a 
straight line.
"The best lightning rod for your protection is your own spine."
- Ralph Waldo Emerson

Scoliosis is an abnormal spine condition that affects millions of Americans. Hallmarked by a lateral curvature of the backbone, it is mostly diagnosed in children ages 10-15 (Fig 1).  Questions remain regarding effective ways to predict curve worsening over time in order to create the appropriate treatment plan.  Research is currently being investigated to address the matter, with DNA testing showing promising results.

There are three types of scoliosis: mild, moderate, and severe.  Each type is classified according to the Cobb method, which measures the acute angle of the side-to-side spinal curve formed in an X-ray (Fig 2).  Mild scoliosis is designated by a Cobb angle of 10-20 degrees, moderate scoliosis by 25-45 degrees, and severe scoliosis by a Cobb angle greater than 50 degrees [1].  Theses types generally begin in childhood.

Fig 2. The three types of scoliosis and associated Cobb angles.
Posted from The Wall Street Journal; Sources: Peter Newton/Randy Children's Hospital San Diego
Scoliosis in children are termed adolescent idiopathic scoliosis (AIS).  5% of children develop AIS by the age of 15. 10% of those have clinical symptoms associated with the ailment, with a female-to-male ratio of 4:1 [2].  As a result, children 10-15 years of age should be routinely screened for the condition [3]. Once a child develops scoliosis, it is uncertain whether the spinal curvature will significantly worsen over time.  This has led to mixed opinions among clinicians on when surgery, fitting a body brace or doing nothing is necessary to prevent potential compromise of respiratory and cardiovascular function caused by further deviation.  Consequently, finding an effective screening strategy for scoliosis is vital.  One such option is a new genetic test called ScoliScore.

The DNA prognostic test, ScoliScore, is used to assess the risk of curve progression in scoliosis patients with a Cobb angle between 10-25 degrees [4].  A 2012 study compared the risk assessment between ScoliScore and traditional screening plans and discovered that the genetic test correctly predicted progression in sixteen times more mild risk patients and five times fewer moderate risk patients [4].  These findings potentially save the patient from additional exposure to x-rays and several appointments to monitor curve progression. Moreover, the need for bracing, which is commonly administered for curves of more than 20-25 degrees as a preventative measure, is drastically reduced [5].  Thus, ScoliScore may save patients from exponential stress and spending thousands of dollars annually.

Scoliscore is an incredible advancement in modern medicine.  With a single test, physicians can reliably predict spinal curve progression, achieving what previously took years of examination, patient burden, and financial strain.  As research in neuroscience continues to advance, a boom in other innovative screening plans may be a few years away.


References:
1. Landro, Laura. "Weighing the Treatment Options for Scoliosis." The Wall Street Journal. Dow Jones & Company, 21 May 2012.
2. Kuchera, W.A., Kuchera, M.L. Osteopathic Principles in Practice. Second Edition (revised), Columbus, Greyden Press, 1994.
3. Savarese, R.G. OMT Review. Third Edition. 2009.
4. Roye, B.D. et. al. Does ScoliScore(TM) Provide More Information Than Traditional Clinical Estimates of Curve Progression. Spine. May 2012: Epub ahead of print.
5. Carlson, B. ScoliScore AIS Pronostic Test Personalizes Treatent for Children With Spinal Curve. Biotechnology Healthcare. Summer 2011: 8(2): 30-1.


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3 comments:

  1. UnknownJuly 8, 2012 at 10:25 PM

    Thank you for sharing this test! I have not heard of it before. Do you have any idea what the cost of the test is? I would imagine it would be much less expensive than the alternative cost of follow-up appointments, X-rays and potentially braces, let alone the emotional toll of those. Also, do you have any idea when this test will become widespread and available for the average clinician to order? Thank you!

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  2. The LobotoJuly 9, 2012 at 3:04 PM

    Great questions Dr. Gibson. The ScoliScore AIS Prognostic Test is fairly new, and I am unaware of when it will become available to all clinicians. It costs $2,950, while bracing costs $1,000-5,000 (not including the fees for getting the brace fitted by a physician, x-rays, and other expenses. The total annual cost for one child with scoliosis is around $24,000, according to the National Scoliosis Foundation). Additionally, adolescents usually need 2-3 braces until adulthood, depending on their rate of growth.

    Now, this is where it gets interesting. The cost of bracing, like many other procedures, are typically covered by a patient's insurance policy. As you are well aware, these compensations come out of a pool of money insurance members pay into. Once you consider that only 5% of an estimated 30,000 children put into braces progress to a Cobb angle that require surgical intervention, it becomes evident how ScoliScore (and other tests yet to be discovered) could relieve some of the financial strain that plagues the American Health Care System today. We must continue to emphasize prevention and screening/testing early (or knowing when to not screen/test at all, as discussed in David Newman's "Hippocrates" Shadow").

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  3. UnknownJuly 9, 2012 at 4:31 PM

    Thank you for your response. Hopefully this new test will become widely available (and covered by insurance) in the near future!

    ReplyDelete

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