| Abstract|| |
A prospective study was carried out to determine incidence rates and distributions of various parameters associated with scoliosis amongst school children of lower Assam, India. A total of 16,912 children (9,274 girls and 7,638 boys) between five to 16 years were screened using the Adams forward bending test. The average age of children with positive findings at the time of examination was 10.6 years and the highest number of cases was observed in the age group of 11-13 years. The results showed that the incidence rate of scoliosis in this study was 0.2 percent with a female to male radio of 2.2: 1. Idiopathic variety was the most common aetiological curve type and the most common curve location was thoracic. In approximately 72 percent of cases the patients / parents were unaware of their deformity.
Keywords: Scoliosis - Screening - School Children
|How to cite this article:|
Saikia K C, Duggal A, Bhattacharya P K, Borgohain M. Scoliosis: An epidemiological study of school children in lower Assam. Indian J Orthop 2002;36:243-5
|How to cite this URL:|
Saikia K C, Duggal A, Bhattacharya P K, Borgohain M. Scoliosis: An epidemiological study of school children in lower Assam. Indian J Orthop [serial online] 2002 [cited 2019 May 24];36:243-5. Available from: http://www.ijoonline.com/text.asp?2002/36/4/243/35942
| Introduction|| |
Scoliosis constitutes a major proportion of spinal deformities and remains one of the most difficult problems in orthopaedic practice. Not only does it affect the child's physical appearance, it also affects child's self-esteem. Moreover, scoliosis if severe also shortens life. Scoliosis can be detected by early screening of school children. By early detection, many curves can be prevented from reaching a severe magnitude.  Despite the tremendous advancements and the giant leaps taken in the management of scoliosis in the last decade, it has become clear that the most successful treatment of this condition is based on early detection.
The study commenced in July 1997 with an aim of finding out the incidence of scoliosis in this area. Evaluation of the aetiological factors, extent of the deformity and patient / parental awareness about the deformity were the additional objectives.
| Material and Methods|| |
The prospective study was carried out in 52 schools of various districts of lower Assam, India during the period from July 1997 to December 1999 cover by 16, 912 (9,724 girls and 7,638 boys) school children in the age group of five to sixteen years over a 30 months period.
The screening and subsequent examinations and follow up were done as per the universally used three tier system. Initial screening of the children was done at their schools. They were screened by the Adams forward bending test. The actual screening examination begins with the patient standing straight and back to the examiner. Next the patient is asked to bend forwards at the hip to nearly 90 degrees. A consistent early sign of scoliosis is in asymmetrical prominence of one side of the thoracic or lumbar area. Those children found to have positive physical signs were advised to undergo a secondary screening at the hospital. Those patients who were found to have structural curves were subjected to further examination and roetgenographic evaluation.
We collected data as per age, sex and anthropometric measurements including sitting and standing height and lower limb length. Birth and family history were enquired about. The physical signs we looked for were shoulder level discrepancy, scapular and flank asymmetry, rib and lumbar hump and high hip, spinal imbalance and flexibility. In evaluation of X-rays, site, size and extent of curves were emphasised.
| Results|| |
We screened a total of 16,912 children (9,274 girls and 7,638 boys). The number of patients with positive signs was 36 (25 girls and 11 boys) [Table 1]. The average age of children with positive findings at the time of age of children with positive findings at the time of examination was 10.6 years. The overall incidence rate was 0.2 percent and the female to male ratio was 2.2:1. The estimated incidence rates for boys and girls were 0.14% and 0.26% respectively, with girls having a higher rate of incidence.
Idiopathic scoliosis constituted the largest group in our study (52.7%). It was followed by postural (27.7%) and congenital (13.8%). The limb length inequality and neurofibromatosis were seen in 2.7% each. There was no case of neuromuscular (poliomyelitis, cerebral palsy) scoliosis [Table 2]. Single major thoracic curve was the most frequently observed curve pattern (55.5%). It was followed by single major thoracolumbar (33.3%) and single major lumbar (11.2%) curves. We did not find any one having double major curves [Table 3].
Shoulder elevation was present in 75% cases. Flank asymmetry was present in all the cases and scapular asymmetry was present in 88.8%. Rib hump was seen in 61% of cases and lumbar hump in 27.7%. Hip prominence was seen in 47.7%. In one case of neurofibromatosis showed associated cafe au lait Spots and moluscum fibrosum. Curves were more severe in girls as compared to boys. Surprisingly parents of 26 children (72.2%) were not aware of the deformity.
| Discussion|| |
The earliest reported study of incidence included analysis of 50,000 minifilms made for a survey analysis of chest disease in the state of Delaware.  This study reported 1.9 percent of the population over 14 years old had scoliosis of at least 10 degrees and that 0.5 percent had scoliosis of 20 degrees or more with female to male ratio of 3.5: 1.
Bruszewski and Kamza  after studying 15,000 serial roentgenograms found an incidence of scoliosis of 3.7 percent. Kane and Moe  in their study in Minnesota found the incidence rate of 0.33 percent for scoliosis requiring referral to an orthopaedist. They also found five to one female predominance. Other series have reported incidence from 1.3 to 1.8%. ,,
In Minnesota  14, 73,697 children, aged 12, 13 and 14 were screened over a period of 7 years. 3.4 percent of the children were referred for detailed evaluation and 1.1 percent had confirmed scoliosis. Koga et al  found the incidence of scoliotic deformity of more than 20 degrees between 0.06 percent to 0.09 percent in elementary school and 0.35 percent to 0.40 percent in junior high school. Smyrmis et al  in their school screening in Greece found a prevalence rate from 1 percent in 8 year olds to more than 3 percent in 15 year olds.
World over the prevalence rates of scoliosis have been found to be more or less in the same range, varying from 0.064%  to 1.9%  to 3.1%  . Our study found a prevalence rate of 0.2 percent.
Quite a few studies in the western world recommended delayed screening in the age groups of 12-13 or 11-14 years. In our study, we found high incidence of cases in the younger age group of 5-7 years. Ten patients (8 girls & 2 boys) constituting 27.7% were in this age group in our study. The youngest patient was five years old. The average age of children with positive findings was 10.6 years. Females outnumbered males by ratio of 2.2: 1. A reason for the higher reported incidence is probably due to the fact that ribhumps are one of the most common physical signs and they are more common in females than in males. In our study, thoracic curves were the most common type of curves followed by thoracolumbar and lumbar curve. The reason could be that thoracic scoliosis is most easily detectable by physical signs.
Few would debate the value of being able to detect scoliosis in its early stages so that early treatment can have its best chance at minimising the physiological and psychological sequelae of the deformity. The establishment of a safe and much more cost effective means of follow up will enhance the value of school screening programmes.
We conclude that scoliosis in this part of the world is more prevalent than previously believed. We are of the opinion that school screening should cover the age group 5-7 and 10-13 years. These age groups correspond with the growth spurts and scoliosis is known to aggravate during this time period. The Indian girl-child being more clothed and with less outdoor activities, lessens the chances of her parents noticing the spinal deformity. Moreover, there is low awareness amongst the population regarding such deformities. Special efforts should be made to educate the people, make them more aware and change their outlook regarding such deformities.[Table 4]
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K C Saikia
Department of Orthopaedics, Guwahati Medical College & Hospital, Guwahati - 781 032
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4]