Erica Yan Ping Po, Jason Pui Yin Cheung, Kenny Yat Hong Kwan, Alec Lik Hang Hung, Tsz Ping Lam, Jack Chun Yiu Cheng, Teng Zhang, Graham Ka Hon Shea, Kenneth Man Chee Cheung, Yik Chung Wu, Daniel Yee Tak Fong
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引用次数: 0
Abstract
Background: The United States Preventive Services Task Force cites insufficient evidence that treating screen-detected AIS improves long-term health outcomes, questioning the value of screening.
Purpose: To assess the association between a 30-year sustained territory-wide scoliosis screening program and long-term trends in surgical threshold attainment for AIS following the Scoliosis Research Society's criteria.
Study design/setting: Population-based longitudinal cohort study PATIENT SAMPLE: We included adolescents aged 10-19 years with AIS and Cobb angle ≥ 20° between 1995 and 2024 from the two tertiary referral scoliosis clinics.
Outcome measures: Trends in surgical threshold attainment for AIS.
Methods: Age-period-cohort (APC) analysis assessed temporal trends associated with the screening program, with Kaplan-Meier and adjusted Cox modelling as sensitivity analyses.
Results: With an overall screening rate of 90.3%, representing 30,818 adolescents, 26,232 (76.9%) females were identified; 2,563 reached surgical threshold (2,011 [78.5%] females). APC analyses showed a pronounced decline in surgical threshold attainment (RR: 1.00 to 0.18) with significant period and cohort effects (p<0.001). Kaplan-Meier and Cox analyses demonstrated improved surgical threshold-free survival (χ² = 93.8, p<0.001) and lower hazards of surgical threshold attainment associated with screening (HR: 0.29; 95% CI, 0.27- 0.32; p<0.001). Concurrently, AIS prevalence with Cobb angle ≥ 20° increased from 0.02% (95% CI, 0.01% - 0.02%) in 1995 to 1.59% (95% CI, 1.56% - 1.62%) in 2019.
Conclusions: This 30-year population-based study provides evidence that screening, by enabling earlier detection, is associated with substantial and sustained decline in surgical threshold attainment. This decline was likely multifactorial, reflecting concurrent advances in conservative management and clinical care. These findings provide important longitudinal evidence to inform scoliosis screening recommendations.
期刊介绍：
The Spine Journal, the official journal of the North American Spine Society, is an international and multidisciplinary journal that publishes original, peer-reviewed articles on research and treatment related to the spine and spine care, including basic science and clinical investigations. It is a condition of publication that manuscripts submitted to The Spine Journal have not been published, and will not be simultaneously submitted or published elsewhere. The Spine Journal also publishes major reviews of specific topics by acknowledged authorities, technical notes, teaching editorials, and other special features, Letters to the Editor-in-Chief are encouraged.
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