Early Scoliosis Screening for Children Ensures Effective Treatment

Dr. LUK Dip Kei, Keith

Honorary Consultant in Orthopaedic Surgery and Specialist in Orthopaedics & Traumatology

Adopted in both public and private sectors locally, comprehensive scoliosis screening was first introduced for local school children through the Student Health Services in 1995. With millions of screenings after nearly three decades, it is now one of the world’s most successful such programmes in terms of early detection and reducing the need for surgery.

Scoliosis can be broadly grouped into 3 categories, namely congenital, idiopathic and degenerative. Adolescent idiopathic scoliosis presents as a sideway, C-or S-shaped curvature of the spine, most likely caused by genetic mutation. As the name implies, the condition arises and deteriorates only during puberty, i.e. from the age of 10 to 14 or 15. According to the Department of Health, about 2 to 3% of adolescents in Hong Kong have scoliosis of varying degrees, with the ratio of female to male patients being 6:1. If left undiagnosed and untreated, scoliosis could lead to impaired cardiopulmonary function and visible deformities, followed by various complications as the spine degenerates with age.

Hong Kong: A Pioneer in Comprehensive Scoliosis Screening

Upon graduating from the University of Hong Kong in 1977, Dr. LUK Dip Kei, Keith, Honorary Consultant in Orthopaedic Surgery and Specialist in Orthopaedics & Traumatology, spent his early professional years at the Duchess of Kent Children’s Hospital as an orthopaedic surgeon and specialised in, among others, treatment of scoliosis. Already an institution of world repute, the Duchess of Kent Children’s Hospital was then the only hospital in Hong Kong that provided treatment to children with scoliosis. Back in the 1980 – 90s, about 140 surgeries were performed for severe cases each year, with some patients coming all the way from less-developed countries to seek treatment despite limited means.   

Surgery for severe scoliosis is a high-skill, small-volume procedure. It must be performed by specialists in orthopaedics with special training in this field. After extensive lobbying of Dr. LUK and his team since the early 1990s, the Department of Health finally agreed to introduce voluntary scoliosis screening for local school age children in 1995. For decades, the programme has been successful in reducing the need for surgery by identifying the suspected, high-risk and early cases at the earliest opportunity for timely follow-up and continued surveillance throughout puberty. Now covering over 90% of local school children, it is recognised worldwide as the leading example in terms of person-times and detection rate.^1,2,3

Prevent Disease Progression with Early Detection and Proper Follow-up

The success of the Hong Kong’s scoliosis screening programme lies in its 3-tier protocol and clear pathways. Eligible school children are first clinically assessed by DH doctors with related training, e.g. looking for uneven shoulders while bending forward. Those suspected with scoliosis are then referred to tier 2 for non-radiation photographic screening, or for radiographs if there is a high suspicion. Confirmed cases will be referred to tier 3 for follow-up by orthopaedic specialists. To prevent disease progression, children in tier 3 may need to be put under surveillance, wear back brace, or undergo surgery depending on the severity. While achieving a high detection rate, the whole screening process is safe and easy-to-follow. It is also of minimal impact on the children’s health without exposing them to radiation unnecessarily.          

Since it is difficult to predict the onset of scoliosis, school children must undergo assessment every year until puberty ends.

No Need for Surgery with Continued Surveillance during Puberty

Despite the success of scoliosis screening in Hong Kong, misconceptions still abounds about the causes of scoliosis and its treatment. In fact, claims like “scoliosis is caused by wrong sitting postures or carrying heavy schoolbags, and therefore can be “corrected” by massage, chiropractic practice or even “bone setting” of traditional Chinese medicine are more than just scientifically unfounded. They can be costly not only in terms of money but also in missing important treatment opportunities.

Delays in treatment may also be attributable to the fact that adolescent patients fail to talk about their condition due to embarrassment or parents’ indifference. It means treatment is often not sought until the deformities become visible and surgery inevitable, taking a heavy toll on the patients’ physical and mental health.

All in all, scoliosis is not something to be taken lightly in view of its adverse impact on children’s growth and self-image if untreated. After nearly three decades of development, our scoliosis screening programme is well-recognised for its robustness and clinical effectiveness^4,5. There is simply no excuse for parents not signing their children up for the Student Health Services, or opting for structured screening and appropriate follow-up by a team of experienced specialists in the private sector.

References:

1. Screening for the Early Detection of Idiopathic Scoliosis in Adolescents, Position Statement of American Association for Orthopaedic Surgeons (https://www.aaos.org/contentassets/1cd7f41417ec4dd4b5c4c48532183b96/1122-screening-for-the-early-detection-of-idiopathic-scoliosis-in-adolescents1.pdf)

2. Luk DK, Lee CF, Cheung KM, et al.: Clinical effectiveness of school screening for adolescent idiopathic scoliosis: a large population-based retrospective cohort study. Spine 2010;35:1607-1614.

3. Lee CF, Fong DY, Cheung KM, et al. Costs of school scoliosis screening: a large, population-based study. Spine (Phila Pa 1976) 2010;35:2266-2272.

4. Fong DY, Cheung KM, Wong YW, Wan YY, Lee CF, Lam TP, Cheng JC, Ng BK, Luk KD: A population-based cohort study of 394,401 children followed for 10 years exhibits sustained effectiveness of scoliosis screening. Spine J. (2015) 15:825–33. 10.1016/j.spinee.2015.01.019

Fong DYT, Luk KDK: Should screening for scoliosis be conducted? ArgoSpine News & Journal 2012, 24(1-2):46-49