Screening children for scoliosis is worth an extra minute in a well-child visit, especially during preteen and teen growth spurts, according to experts.

Early identification allows for observation or brace treatment before curves become severe enough to require surgery and increases the chances of preserving spinal motion and minimizing long-term impact, according to Scott J. Luhmann, MD, professor of orthopedic surgery at Washington University School of Medicine in St. Louis.

“Rapid skeletal growth during puberty is the period when spinal curves are most likely to appear and progress,” said Luhmann, chair in the 2026 International Congress on Early Onset Scoliosis and the Growing Spine.

Scoliosis affects approximately 6-9 million people in the US, with most cases appearing between the ages of 10 and 15 years, according to the American Association of Neurological Surgeons. Although the prevalence is similar across genders, females are eight times more likely to progress to a degree of curvature that requires surgery.

In 2018, the US Preventive Services Task Force (USPSTF) deemed evidence insufficient to recommend for or against routine scoliosis screening, and that guidance remains unchanged. Yet many groups, including the American Academy of Pediatrics, recommend screening girls at approximately ages 10 and 12 years, and boys at approximately ages 13 or 14 years. The USPSTF recommendation acknowledges the support for screening by various medical groups, and states that clinicians should tailor clinical decision-making to the patient or situation, which involves considerations beyond evidence or lack of evidence.

In an editorial accompanying the 2018 recommendations, John F. Sarwark, MD, and Matthew M. Davis, MD, MAPP, both affiliated with the Ann & Robert H. Lurie Children’s Hospital of Chicago in Chicago noted that the lack of evidence of the short-term effects of scoliosis screening for adolescents and the long-term health outcomes into adulthood remains a barrier to moving recommendations out of the insufficient evidence range.

Despite the lack of endorsement by the USPSTF, specialists generally recommend early screening by primary care providers so children can be referred to a pediatric orthopedic specialist for full evaluation if indicated. “The Adams forward bend test takes perhaps 30 seconds during routine well-child screening,” said Sarwark, also a professor in the department of orthopedic surgery at Northwestern University Feinberg School of Medicine, in an interview.

How to Screen?

Screening for scoliosis in primary care starts with a visual observation of the child standing up straight, feet together and arms relaxed, with the screener checking for discrepancies in shoulder height, a prominent scapula, asymmetry at the waist, or tilted hips. Next, the child should bend forward at the waist until their back is parallel to the floor so the screener can check for a rib hump or lower back prominence that might signal spinal rotation (the Adams forward bend test). Any asymmetry on observation should be checked using a scoliometer to determine the angle of trunk rotation.

The generally accepted guideline is to refer to a specialist if the scoliometer reads 7° for normal weight children, 6° for those who are overweight, and 5° for children with obesity, according to experts at the Spine Center of the Children’s Hospital of Philadelphia.

Other criteria for referral include an obvious rib prominence or lumbar asymmetry on the Adams forward bend test, visible shoulder or waist asymmetry, trunk shift, or significant back pain associated with neurologic symptoms, said Luhmann.

Treatment Trends

Bracing for young patients with curves greater than 25° can mitigate the effects of rapid growth spurts on scoliosis, according to Brent O’Neill, MD, a pediatric neurosurgeon at Penn State Health in Lancaster, Pennsylvania. Currently available next-generation braces use three-dimensional (3D) imaging for more customized designs that help correct curves over time, and AI apps and wearable sensors track wear time and monitor alignment.

“Most patients with curves under 25° do not need specific treatment, but they will need follow-up, and some deserve additional testing,” O’Neill said.

Surgery is generally recommended for patients with spinal curves greater than 50°. Spinal fusion, which has the longest track record and best data for success, is the most common and most studied procedure, said O’Neill.

Surgical implants for scoliosis have improved steadily over the past 40 years, O’Neill noted. “The pedicle screws and deformity correction systems are vastly different than the screws and rods used in past decades, and allow much better correction of deformity,” he said. In addition, new imaging technologies allow surgeons to see scoliosis and treat it in new ways. For example, surgical robots offer the potential for more accurate placement of screws, and 3D imaging avoids the radiation exposure of a standard x-ray, said O’Neill. “Artificial intelligence is being applied to these 3D imagines and to the surgical robot planning, with careful supervision from the surgeon,” he said.

“Many of these systems are new enough that we don’t fully know the outcomes and how best to use them, but refinements and more experience will lead to better results,” O’Neill added.

Obesity’s Impact

Scoliosis is more likely to be missed in screening of children and teens with obesity, but when it is identified, it is more likely to be severe, recent data suggested. Researchers at the Children’s Hospital of Philadelphia compared data from 150 pediatric patients aged 10 years or older with 50 in each group with normal weight, overweight, or obesity. They found that the average spinal curves at presentation to a spine specialist were 18.1°, 23.9°, and 24.5° for patients with normal weight, overweight, and obesity, respectively.

“Obesity can mask trunk rotation and rib prominence, reducing the sensitivity of visual inspection alone,” Luhmann noted. “Maintaining a lower threshold for referral in obese patients and relying more heavily on objective scoliometer measurements rather than visual assessment alone, may reduce delayed diagnosis of clinically significant curves,” he added.

Looking ahead, prospective studies are needed to evaluate the effectiveness and cost-effectiveness of modern scoliosis screening strategies in diverse populations, including children with obesity and historically underserved groups, said Luhmann.

Other avenues for research include refining referral thresholds using scoliometer measurements across different body types, incorporating emerging technologies such as 3D surface topography and AI-assisted image analysis, and identifying biomarkers or other predictors that more accurately estimate curve progression risk, Luhmann said.

Sarwark, Luhmann, and O’Neill disclosed having no financial conflicts of interest.