Abstract
fered surgery. Occasionally when a child is still prepubertal and the curve is greater than 30 degrees a brace may be offered. Despite bracing being common in continental Europe however it is still uncommon in the UK. Furthermore although physiotherapy is offered as an option for curves ranging from 20 to 30 degrees in most countries in continental Europe, it is currently not offered as an option in the UK. This lack of screening in the UK has meant that many children at our centre are not detected till the curvature is 40 degrees or above and then the only option left for patients is surgery. Clinicians opposed to school screening have suggested a number of factors in support of their decisions. Obsolete assumptions, the low prevalence of IS, the high false positives and costs have all been quoted. The policy not to screen because of a lack of cost effectiveness is based on the obsolete assumption derived from a study dating back to 1941 that surgery is the only proven treatment option. However the study cited in this report does not scientifically justify the conclusion (SOSORT 2008). Today there is evidence that if detected early enough the signs and symptoms, as well as the rate of progression of scoliosis can be modified by the application of intensive scoliosis specific exercise programmes. Furthermore the numbers of patients referred for surgery can also be significantly decreased in countries where conservative treatment (physiotherapy and braces) is available to a high standard. This paperwill discuss the scientificevidence in support of all of the above as well as specific evidence based recommendations for the improvement of school screening effectiveness and patient choice.
Published Version
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