Scoliosis (School) Screening Guideline Publications


The Canadian Scoliosis Screening Coalition

www.ScoliosisCanada.ca            contact us by email: CSSC@scoliosiscanada.ca

Revised Feb 2, 18, Mar 7, 13, 2026.

US State Scoliosis School Screening Guideline publications:

MILLIONS of children are screened for Scoliosis annually in schools all over the world from grades 5 to 7 or 8 in countries including Japan (since 1979), China, Hong Kong, Malta, Malaysia, Singapore. Belgium, Croatia, Greece, Hungary, Slovenia, Sweden, Spain, Iran, Saudi Arabia, Turkey, Nigeria, Brazil, Chili and others. All conduct annual school screening programs nationally. But NOT Canada. As of 2024, 29 US states conduct annual scoliosis screening in schools, including Arizona, New York, California, Colorado, Connecticut, Florida, Georgia, Louisiana, Nevada, Pennsylvania, Texas, Virginia and Utah (see National Scoliosis Foundation Scoliosis Screening Map ). Yet, shamefully, not one province in Canada screens children. Scoliosis School Screening, SSS, ended in Canada in the early 80's, after a brief decade, after a failing C grade due to “poor evidence” was published in a report from the Canadian Task Force on Periodic Health in 1979 (now replaced by the Canadian Task Force on Preventative Health Care under public health Canada). There is now high quality evidentiary studies to support screening for Scoliosis, as well, it will save millions in healthcare utilization costs and more importantly benefit the lives of Canadian children.

Another consequential failure in Canadian public health for Canadian children is that primary care providers do not perform annual health checks on children to check their spines for scoliosis. A quick physical simple exam that takes mere minutes. A related concerning issue, the level of knowledge of scoliosis and conservative management of scoliosis is very low amongst primary care providers. Yet, if primary care providers across Canada, performed an annual check for scoliosis on children at the high risk pre-puberty ages this would mitigate the lack of provincial school screening programs and ensure many children with scoliosis would be diagnosed early and receive appropriate timely conservative medical care.

Below are links to a few Scoliosis Screening publications of the 29 US States that have annual Scoliosis School Screening programs for Canadian Public Health and Education policy makers to study. The highly respected National Scoliosis Foundation (US non-profit patient-led organization established in 1976) provides assistance to US States to set up school screening as well as international countries. The US states refer to the
Screening Procedure Guidelines Spinal Guidelines Recommendations for Examiners Published by the Scoliosis Research Society.


Texas Spinal Screening Program School Spinal Screening Guidelines Sept 2018 Texas Department of State Health Services, Texas Health and Human Services, ..all children must undergo screening for abnormal spinal curvature per the following schedule: "...Girls will be screened two times, once at age 10 (or fall semester of grade 5) and again at age 12 (or fall semester of grade 7). Boys will be screened one time at age 13 or 14 (or the fall semester of grade 8).... Schools must identify exceptions (i.e., children promoted to higher grades or held back) and ensure their screenings align with appropriate ages rather than grades...." See more at Screening Information and Procedure"...Spinal screening instructors must complete a department instructor training course. They must first meet the following qualifications:...Be physicians, chiropractors, physical therapists, or registered nurses..."

New York Scoliosis Screening Guidelines for Schools 2018 The University of the State of New York The State Education Department Office of Student Support Services ( provides schools with a framework for establishing a scoliosis screening program ) “...requires that scoliosis screenings are conducted in school... in grades 5 and 7 for girls, and grade 9 for boys....”

California Standards for Scoliosis Screening in California Public Schools California Department of Education 2007 “...Existing law requires that all female students in grade seven and all male students in grade eight be given scoliosis screening by qualified personnel...”




Screening Program Guidelines & Position Statements:

The Canadian Scoliosis Screening Coalition strongly urges public health and health ministers follow the recommendations in the recent Canadian publication *** Scoliosis Screening: A Review of Current Evidence, Worldwide Practices, and Recommendations for Implementation Across Canada . The two top highly respected international medical societies for the field of care of patients with Scoliosis and spinal deformities are the Scoliosis Research Society (SRS) and SOSORT the International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (conservative non-surgical treatment).

The Canadian Scoliosis Screening Coalition and the Canadian Paediatric Spine Society agree (& US State schools screening programs follow) with the collaborative revised 2015 *** Position Statement Screening for the Early Detection of Idiopathic Scoliosis in Adolescents *** by The Scoliosis Research Society (SRS), American Academy of Orthopaedic Surgeons (AAOS), Pediatric Orthopaedic Society of North America (POSNA), and American Academy of Pediatrics (AAP). And the SOSORT (the International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (conservative non-surgical treatment) a non-profit International society of Doctors, Physical Therapists. Orthotists and Psychologists formed in 2003 for Scoliosis care) publication *** 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth ***




Managing Adolescent Idiopathic Scoliosis:

(HEALTH ALERT Revised Mar 7/26 :
PRIMARY CARE PROVIDERS NEED TO BE AWARE that spinal deformities, Scoliosis (from mild to severe), Kyphosis, early & severe Spondylolesthesis, very rare Kyphoscoliosis, often along with pees planus (flat feet) in a small subset of paediatric patients (and adults) can be clinical presenting signs of an underlying rare genetic connective tissue disorder usually referred to as a Heritable Connective Tissue Disorder (HCTD), IF accompanied by other features and symptoms. These HCTDs can weaken (supportive) connective tissue found in many places of the body including skin, ligaments, cartilage, bones, eyes, teeth, joints, even walls of organs and blood vessels. Symptoms can range from mild to severe. HCTDs includes MARFAN SYNDROME (MFS) characterized by distinguishing features, which may include: disproportionately long arms, legs, fingers, tall, slender body build, flat feet (pees planus), hypermobile or loose joints, sunken or portruding chest, long narrow head, narrow jaw, crowded teeth, ectopia lentis, near-sightedness (myopia), stretch marks not related to weight gain or loss, as well as LOEYS-DIETZ SYNDROME (LDS) (more agressive cardiovascular disease then MFS) where distinguishing features may include widely spaced eyes, bifid uvula, cleft palate, clubfoot, high-grade spondylolisthesis, poor wound healing, soft velvety skin that bruises easily, eczema, cervical instability (and more) , and shared features with MFS of flat feet, hypermobile loose joints, and chest deformity and some very rare subtypes (Kyphoscoliotic EDS (kEDS) & vascular EDS (vEDS)) of EHLERS-DANLOS SYNDROMES (EDS), that share the features of hypermobile or loose joints (joint hypermobility), loose stretchy skin (skin hyperextensibility), and tissue fragility (can present as easy bruising and poor wound healing) and have their own unique additional features and identifying gene markers.
   WHY THIS MATTERS:
Public health in Canada does not screen children for rare diseases. It is critically important to recognize that children (& young adults) with these genetic/heritable connective tissue disorders — are at high risk of serious cardiac and vascular (cardiovascular) complications including aortic enlargement, which can lead to life-threatening aortic dissection (rupture) causing premature death. EARLY DIAGNOSIS by referral to a cardiologist/aortic specialist clinic for a cardiac examination that includes an echocardiogram and referral to a medical geneticist (for molecular genetic testing) is critically important. FOR INFORMATION/REFERENCES and WHERE TO FIND HELP (for referrals) please click on ==> Links to resources and references on HCTDs. Please watch Family of woman who died after undiagnosed Marfan syndrome speaks out CTV News, Toronto News, Jan 7, 2026 and the Ontario family's Federal Petition advocating screening for rare diseases. Early identification and preventative management of cardiovascular disease in HCTDs can significantly reduce morbidity and mortality.  )

  • Kuang H, Chen L, Huang M, Chen J. Management of adolescent scoliosis: a comprehensive review of etiology and rehabilitation. Front Pediatr. 2025 Jul 16;13:1596400. doi: 10.3389/fped.2025.1596400. PMID: 40740816; PMCID: PMC12307321."...By identifying key research gaps and proposing innovative future directions—such as the integration of epigenetics, advanced biomechanical modeling, and AI-driven precision rehabilitation—this article aims to provide clinicians and researchers with a comprehensive framework for managing AS. Ultimately, this review underscores the importance of early detection, personalized treatment, and long-term follow-up in enhancing the quality of life for adolescents with scoliosis..."
  • Creech-Organ J, Leggit JC. Musculoskeletal Issues in Children and Adolescents: Adolescent Idiopathic Scoliosis. FP Essent. 2024 Sep;544:20-23. PMID: 39283674.
  • Andreeff, Renee EdD, PA-C, DFAAPA1,a; Andreeff, Autumn2. New and Traditional Treatment Options for Idiopathic Scoliosis in Children and Adolescents. JBJS Journal of Orthopaedics for Physician Assistants 12(2):p e23.00022, April-June 2024. | DOI: 10.2106/JBJS.JOPA.23.00022 "...Traditional treatments include observation, rigid bracing (a corrective orthosis), casting, surgery, and physiotherapeutic scoliosis-specific exercises. Surgical corrections include spinal fusion or placement of traditional or growing rods. Treatment options for scoliosis have recently expanded, to include newer flexible bracing and surgical procedures such as tethering and posterior dynamic deformity correction. Providers should be screening for scoliosis, and all providers can benefit from knowing the latest options available to help their patients receive the best care before reaching skeletal maturity..."
  • ***Moroz, P, Romeo J, Abouassaly M. Managing Adolescent Idiopathic Scoliosis (AIS) in Primary Care: Screening, Imaging and Successful Referral BackHealth Journal of Current Clinical Care Volume 5, Issue 3, 2015. "...The ability to conduct a quick effective scoliosis examination is important for the busy practitioner. This article illustrates the main features of the screening test, offers guides for imaging, and outlines appropriate tips for specialist referral..."

    Awareness and Knowledge of Scoliosis is low amongst Healthcare Providers:

  • Doucet C, Rousseau P, Pagé I. Level of knowledge on conservative management of adolescent idiopathic scoliosis among undergraduate students in healthcare: A scoping review. Musculoskelet Sci Pract. 2022 Oct;61:102595. doi: 10.1016/j.msksp.2022.102595. Epub 2022 Jun 2. PMID: 35688012."...studies evaluated students in physiotherapy, but using distinct questionnaires. Both studies reported an unsatisfactory level of knowledge...no conclusion can be drawn regarding the level of knowledge of undergraduate health professions' students on AIS conservative management. The development a standardized questionnaire to adequately assess this knowledge across institutions and professions is required."
  • Théroux J, Grimard G, Beauséjour M, Labelle H, Feldman DE. Knowledge and management of Adolescent Idiopathic Scoliosis among family physicians, pediatricians, chiropractors and physiotherapists in Québec, Canada: An exploratory study. J Can Chiropr Assoc. 2013 Sep;57(3):251-9. PMID: 23997251; PMCID: PMC3743651. “...We found that only 66% of the family physicians could mention 2 of the 4 clinical signs of AIS. ..Chiropractors and physiotherapists can constitute a port of entry into the healthcare system...The use of other professionals who have proficiency in the musculoskeletal area might be an efficient way to manage scoliosis and other musculoskeletal conditions and help relieve some of the significant systemic problems of healthcare access. Allowing specialists to accept referrals from other HCPs may improve efficiency.... Conclusion Our study indicated that there were considerable deficits among the study participants in knowledge of the clinical signs and risk factors for curve progression in AIS....”


School Screening Studies and Related Publications:

The following is a curated list.

  1. Jennifer A.Dermott, Liisa Jaakkimainen, Teresa To, Maryse Bouchard, Andrew W. Howard, David E. Lebel, Epidemiologic trends in adolescent idiopathic scoliosis in Ontario: validating a population-based health administrative data algorithm for patient identification. Canadian Journal of Surgery Vol. 68 (6 Suppl 3) December 12, 2025 (page 67) DOI: 10.1503/cjs.020125, Abstract ID 52, Program Code P164, the Hospital for Sick Children, Toronto, Ont.; the University of Toronto, Toronto, Ont.; Sunnybrook Research Institute, Toronto, Ont.; ICES, Toronto, Ont.; the SickKids Research Institute, Toronto, Ont., " Background: This study aimed to estimate provincial epidemiologic trends of adolescent idiopathic scoliosis (AIS) over 10 years, by validating a population-based health administrative data (HAD) algorithm for patient identification..... Methods: This case ascertainment validation study developed 93 algorithms to identify 10- to 18-year-olds with AIS, using a combination of diagnostic, specialty, and/or fee codes related to scoliosis, gathered from physician billings, emergency room records, and discharge data over various look-back periods. A validation cohort was established to evaluate algorithm performance, consisting of 2732 patients with confirmed AIS (positive reference) and 49049 youth without AIS (negative reference), approximating the population prevalence reported in the literature....The algorithm-derived cohort included 27,125 youth, 18358 females (62%) with a mean age of 13.9 ± 1.8 years. Age/ sex-standardized AIS incidence ranged from 118.3 (2020) up to 147.6 (2021) per 100 000 persons. Age/sex-standardized prevalence ranged from 491.7 (2012) up to 541.9 (2021) per 100000 persons. Conclusion: Identification of youth with AIS is possible using a HAD algorithm, with strong discriminative ability. Provincial epidemiologic trends were relatively stable between 2012 and 2021. Our results support this being a promising avenue for conducting population-level AIS surveillance and longitudinal outcome studies in the future.
  2. Huang, Zifang PhDa; Xiaohong, Wang MDa; Zheng, Lingling MSb,c; Liu, Fuyun MDd; Hu, Weiming PhDd; Yang, Dongling MDe; Qi, Wenjuan MDe; Xuan, Xiaoling MDb; Fei, Zhijun MDb; Yang, Jingfan MDf; Yang, Junlin PhDa,b,f. Improving the Effectiveness of Adolescent Idiopathic Scoliosis (AIS) Screening: A Prospective Study. Spine ():10.1097/BRS.0000000000005501, September 15, 2025. | DOI: 10.1097/BRS.0000000000005501 "Plain Language summary: This study assessed a new method for screening adolescent idiopathic scoliosis (AIS) by combining scoliometer-based Angle of Trunk Rotation (ATR) measurements with physical examination findings. Involving 595 participants, the study found that using an ATR cutoff of 5.5° with three clinical signs improved sensitivity to 84.1%. A simplified threshold of 5° with three signs increased sensitivity to 91.5%, though with lower specificity. For severe cases, an ATR of 6° with four signs achieved over 90% sensitivity. The study suggests this combined approach enhances AIS detection, offering a practical, sex- and severity-adapted screening strategy for schools." (note: this large study from Guangzhou, Guangdong, China, where they actuallly have a scoliosis prevention centre and an institute for Child and Adolescent Health, confirms the position statement of Screening for the Early Detection of Idiopathic Scoliosis in Adolescents by the Scoliosis Research Society (SRS), the American Academy of Orthopaedic Surgeons (AAOS), the Pediatric Orthopaedic Society of North America (POSNA), the American Academy of Pediatrics (AAP) and the International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT).)
  3. ***Grivas TB, Vasiliadis E, Mazioti C, Mamzeri A, Papagianni D, Katzouraki G, Sekouris N. To Screen or Not to Screen: "False Positive" Cases-Can They Be Treated as Definitely False? Properly Selecting the Screening Age-Range Groups in Scoliosis Screening Programs. Healthcare (Basel). 2025 Mar 10;13(6):600. doi: 10.3390/healthcare13060600. PMID: 40150450; PMCID: PMC11942112."... This opinion paper provides a brief overview of the history of school scoliosis screening programs following the introduction. Methods: It outlines the international administrative policies of these programs, their impact on the frequency of surgical procedures, and the effects of discontinuing school-based scoliosis screenings...It appears that latitude which differentiates the sunlight influences melatonin secretion and modifies age at menarche, which is associated with the prevalence of IS. Age at menarche is considered a reliable prognostic factor for IS and varies in different geographic latitudes [13]. Consequently, the geographical latitude and menarche will determine the age range groups of children which will be screened. Traditionally the age group is including the fifth and sixth grade of primary school and seventh and eighth grade in high school, but this range must be adjusted according to the latitude of the place because the menarche differs at different latitudes....It has been reported [122] that the decision not to implement screening due to cost-effectiveness concerns is based on an outdated assumption—originally derived from an early study [123] that surgery is the only proven treatment option...Today, evidence demonstrates that signs and symptoms of scoliosis can be significantly improved through intensive inpatient exercise programs... It is also well-documented and widely accepted that bracing alters the natural course of IS [86,125,126,127,128,129,130,131,132,133,134], and that SSS programs reduce the number of patients requiring surgical intervention [86]...Conclusions One reason SSS programs have been discontinued is the occurrence of false positive cases. Many younger children are referred from these programs due to trunk asymmetry but actually have a straight spine or a Cobb angle below 10 degrees, leading to their classification as “false positives”. However, it is highly likely that some of these children may later develop IS as they grow, meaning they should not be definitively labeled as false positives...The recommended age group for screening is adjusted based on latitude, as the timing of menarche varies accordingly. It is advised to conduct screenings within a window of two years before and two years after the average age of menarche in a given country. Ultimately, SSS programs are strongly recommended due to their numerous benefits."
  4. ***Czaprowski D, Tyrakowski M, Dembińska A, Lewandowski J, Kozinoga M, Bloda J, Stoliński Ł, Kolwicz-Gańko A, Kalicki B, Kędra A, Stępień A, Kossakowski D, Piwoński P, Murawski P, Klukowski, Kotwicki T, Screening recommendations for early detection of idiopathic scoliosis – consensus by a multidisciplinary Task Force at Committee for Rehabilitation, Physical Culture and Social Integration of Polish Academy of Sciences Pediatr Med Rodz 2024; 20 (3): 294–30 "Abstract:...The aim of the study was to develop the recommendations for screening of idiopathic scoliosis. Materials and methods: Fifteen experts, including physiotherapists, physicians and physical education teachers, created a Team of Experts in order to develop recommendations. Team members were divided into three groups, each tasked with addressing the following issues: “How to screen?”, “Who and when to screen?”, and “Who should screen?”. The recommendations were evaluated using the Delphi technique and the nominal group technique in two areas: agreement and the strength of recommendations. Results: A total of 16 recommendations for early detection of idiopathic scoliosis were developed. Conclusions: 1. Screening should use reliable, sensitive, and specific diagnostic tools and methods to minimise the risk of under- and overdiagnosis. Measurements of the angle of trunk rotation performed using a scoliometer meet the above criteria. 2. A recommended cut-off for angle of trunk rotation for early detection of idiopathic scoliosis should be ≥7°. ..."
  5. González-Ruiz JM, Mohamed N, Hassan M, Fald K, de Los Ríos Ruiz E, Pérez Cabello P, Redondo ÁR, da Rosa B, Burke TN, Westover L. Clinical and Topographic Screening for Scoliosis in Children Participating in Routine Sports: A Prevalence and Accuracy Study in a Spanish Population. J Clin Med. 2025 Jan 6;14(1):273. doi: 10.3390/jcm14010273. PMID: 39797357; PMCID: PMC11722016."...Conclusions: The clinical screening method showed superior sensitivity and balanced accuracy compared to ST screening. However, ST screening showed higher specificity and PPV, suggesting its potential as a complementary tool to reduce the high positive predictive value. These results highlight the importance of combining screening methods to improve the accuracy of the early detection of IS in physically active children, with the radiographic confirmation of the positive screened cases remaining essential for accurate diagnosis...."
  6. Farid, Alexander R. MD; Hresko, M. Timothy MD; Ghessese, Semhal MD, MPH; Linden, Gabriel S. BA; Wong, Stephanie BS; Hedequist, Daniel MD; Birch, Craig MD; Cook, Danielle MA; Flowers, Kelsey Mikayla MA; Hogue, Grant D. MD. Validation of Examination Maneuvers for Adolescent Idiopathic Scoliosis in the Telehealth Setting. The Journal of Bone and Joint Surgery 106(23):p 2249-2255, December 4, 2024. | DOI: 10.2106/JBJS.23.01146 "...Conclusions: There was a high level of agreement between telehealth and in-person spine measurements, suggesting that THVs may be reliably used to evaluate AIS, thus improving access to specialized care."Level of Evidence: Diagnostic Level II.
  7. Khadour FA, Khadour YA, Albarroush D. Association between postural habits and lifestyle factors of adolescent idiopathic scoliosis in Syria. Sci Rep. 2024 Nov 5;14(1):26784. doi: 10.1038/s41598-024-77712-z. PMID: 39500971; PMCID: PMC11538456. "...The results showed several statistically significant differences between the AIS case group and the healthy control group. A notably lower percentage of AIS participants reported having a normal standing posture than controls (46.8% vs. 72.7%)... the AIS group had lower self-reported participation rates in various sports and physical activities. However, no significant differences were found between groups for time spent in extracurricular classes, proportions with normal vision, schoolbag-carrying habits, or general health status..."
  8. Fu X, Meng S, Huang X, Li W, Ye B, Chen S. The prevalence of scoliosis among adolescents in China: a systematic review and meta-analysis. J Orthop Surg Res. 2024 Sep 28;19(1):585. doi: 10.1186/s13018-024-05077-0. PMID: 39342221; PMCID: PMC11437733.
  9. Yang J, Huang S, Cheng M, Tan W, Yang J. Postural habits and lifestyle factors associated with adolescent idiopathic scoliosis (AIS) in China: results from a big case-control study. J Orthop Surg Res. 2022 Oct 29;17(1):472. doi: 10.1186/s13018-022-03366-0. PMID: 36309689; PMCID: PMC9618226."...Conclusions In conclusion, inappropriate school desk height, anterior pelvic tilt and lateral right sleeping position are associated with elevated AIS risk, while up-straight sitting and changing classroom sitting positions regularly are associated with decreased AIS risks. These findings could inform future school AIS prevention programs."
  10. Luk KD, Lee CF, Cheung KM, Cheng JC, Ng BK, Lam TP, Mak KH, Yip PS, Fong DY. Clinical effectiveness of school screening for adolescent idiopathic scoliosis: a large population-based retrospective cohort study. Spine (Phila Pa 1976). 2010 Aug 1;35(17):1607-14. doi: 10.1097/BRS.0b013e3181c7cb8c. PMID: 20453727."Methods. A total of 157,444 students were eligible for a biennial scoliosis screening, and their screening results and medical records up to 19 years of age were available. Students first had forward bending test and angle of trunk rotation (ATR) performed. Those with ATR between 5° and 14° or signs of adolescent idiopathic scoliosis were assessed by moiré topography regularly. Students with an ATR ≥15°, ≥2 moiré lines, or significant clinical signs were referred for radiography and had their Cobb angle measured.
    Results. Of the 115,190 screened students in the cohort, 3228 (2.8%, 95% confidence interval [CI] = 2.7%–2.9%) were referred for radiography. At the final follow-up, the positive predictive values were 43.6% (41.8%–45.3%) for a Cobb angle ≥20° and 9.4% (8.4%–10.5%) for needing treatment, while the sensitivities were 88.1% (86.4%–89.6%) and 80.0% (75.6%–83.9%), respectively....Conclusion: This is the largest study that has demonstrated that school scoliosis screening in Hong Kong is predictive and sensitive with a low referral rate. Screening should thus be continued in order to facilitate early administration of conservative treatments."
  11. Chen C, Yu R, Xu W, Li Z, Li Y, Hu R, Zhu X. A Practical Study of Diagnostic Accuracy: Scoliosis Screenings of Middle School Students by a Trained Nurse With a Smartphone Versus a Spine Surgeon With a Scoliometer. Spine (Phila Pa 1976). 2020 Mar 1;45(5):E266-E271. doi: 10.1097/BRS.0000000000003256. PMID: 31568349.
  12. Yılmaz H, Zateri C, Kusvuran Ozkan A, Kayalar G, Berk H. Prevalence of adolescent idiopathic scoliosis in Turkey: an epidemiological study. Spine J. 2020 Jun;20(6):947-955. doi: 10.1016/j.spinee.2020.01.008. Epub 2020 Jan 20. PMID: 31972303.
  13. Chen C, Yu R, Xu W, Li Z, Li Y, Hu R, Zhu X. A Practical Study of Diagnostic Accuracy: Scoliosis Screenings of Middle School Students by a Trained Nurse With a Smartphone Versus a Spine Surgeon With a Scoliometer. Spine (Phila Pa 1976). 2020 Mar 1;45(5):E266-E271. doi: 10.1097/BRS.0000000000003256. PMID: 31568349. “Conclusion. This study revealed that smartphone-aided screening for scoliosis is risky.” Level of Evidence: 3
  14. Adamczewska K, Wiernicka M, Malchrowicz-Mośko E, Małecka J, Lewandowski J. The Angle of Trunk Rotation in School Children: A Study from an Idiopathic Scoliosis Screening. Prevalence and Optimal Age Screening Value. Int J Environ Res Public Health. 2019 Sep 16;16(18):3426. doi: 10.3390/ijerph16183426. PMID: 31527403; PMCID: PMC6765789. “Background: Idiopathic scoliosis is a deformity of the growing spine. It affects 2–3% of adolescents; yet its cause is still unknown. At the early stage of idiopathic scoliosis (IS), the signs are not very noticeable. That is why the primarily school-based screening for scoliosis is so important...”
  15. Aulisa AG, Giordano M, Guzzanti V, Falciglia F, Pizzetti P, Toniolo RM. Effectiveness of school scoliosis screening and the importance of this method in measures to reduce morbidity in an Italian territory. J Pediatr Orthop B. 2019 May;28(3):271-277. doi: 10.1097/BPB.0000000000000611. PMID: 30807511. “Our results show that the school screening program was accurate and repeatable. Moreover, screening children for scoliosis using a simple test appears to be an effective means of early detection. Above all, the screening process effectively decreased morbidity in the territory at a negligible cost.”
  16. Penha PJ, Ramos NLJP, de Carvalho BKG, Andrade RM, Schmitt ACB, João SMA. Prevalence of Adolescent Idiopathic Scoliosis in the State of São Paulo, Brazil. Spine (Phila Pa 1976). 2018 Dec 15;43(24):1710-1718. doi: 10.1097/BRS.0000000000002725. PMID: 29877996.
  17. Kuroki H, Nagai T, Chosa E, Tajima N. School scoliosis screening by Moiré topography - Overview for 33 years in Miyazaki Japan. J Orthop Sci. 2018 Jul;23(4):609-613. doi: 10.1016/j.jos.2018.03.005. Epub 2018 Apr 5. PMID: 29628286.
  18. Moalej S, Asadabadi M, Hashemi R, Khedmat L, Tavacolizadeh R, Vahabi Z, Shariatpanahi G. Screening of scoliosis in school children in Tehran: The prevalence rate of idiopathic scoliosis. J Back Musculoskelet Rehabil. 2018;31(4):767-774. doi: 10.3233/BMR-171078. PMID: 29578478. “..Initial screening of the students was done in schools by health care provider or medical student who has been trained by a pediatrician to undergo a vertebral examination. Scoliometer for iPhone's smartphone has been used for measuring the angle of deviation...."
  19. Hengwei F, Zifang H, Qifei W, Weiqing T, Nali D, Ping Y, Junlin Y. Prevalence of Idiopathic Scoliosis in Chinese Schoolchildren: A Large, Population-Based Study. Spine (Phila Pa 1976). 2016 Feb;41(3):259-64. doi: 10.1097/BRS.0000000000001197. PMID: 26866739. “Conclusion: The prevalence rate of IS was 5.14% in our study. Screening of 13- to 14- and 14- to 15-year-old girls identified a significant number who could benefit from preventive treatment “
  20. Yamamoto S, Shigematsu H, Kadono F, Tanaka Y, Tatematsu M, Okuda A, Iwata E, Koizumi M, Tanaka Y. Adolescent Scoliosis Screening in Nara City Schools: A 23-Year Retrospective Cross-Sectional Study. Asian Spine J. 2015 Jun;9(3):407-15. doi: 10.4184/asj.2015.9.3.407. Epub 2015 Jun 8. PMID: 26097656; PMCID: PMC4472589. “We believe that scoliosis screening in schools is useful for detection; however, screening programs are controversial owing to over referral of students who do not require further testing or follow-up...We selected Moiré topography as the scoliosis screening tool...Moiré topography, had a high false-positive rate...Although our screening cost was less than that for surgical intervention in Japan, it was twice as high as that in Minnesota, USA. Our study has highlighted the need for further research in the area of reduction of the false-positive rate of Moiré topography for scoliosis screening.”
  21. 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 May 1;15(5):825-33. doi: 10.1016/j.spinee.2015.01.019. Epub 2015 Jan 20. PMID: 25615844.“...scoliosis screening program can have sustained clinical effectiveness in identifying patients with adolescent idiopathic scoliosis needing clinical observation... scoliosis screening should be continued as a routine health service in schools or by general practitioners if there is no scoliosis screening policy.”
  22. Adobor, R.D., Joranger, P., Steen, H. et al. A health economic evaluation of screening and treatment in patients with adolescent idiopathic scoliosis. Scoliosis 9, 21 (2014). https://doi.org/10.1186/s13013-014-0021-8 “...Scoliosis screening programs are considered to be beneficial from a clinical point of view but are criticized for high costs due to high referral and treatment rates ... Results suggest that screening is cost saving, unless both treatment rates and surgical rates are very low in comparative non-screening scenarios... the present study indicates that costs increase in non-screening scenarios with high rates of surgery and lower rates of bracing.”
  23. Płaszewski M, Bettany-Saltikov J. Are current scoliosis school screening recommendations evidence-based and up to date? A best evidence synthesis umbrella review. Eur Spine J. 2014 Dec;23(12):2572-85. doi: 10.1007/s00586-014-3307-x. Epub 2014 Apr 29. PMID: 24777669. “As the existing recommendations supporting screening are based on moderate quality evidence whilst the recommendations against screening are based on low-quality evidence, the latter recommendations appear to be both unconvincing and methodologically invalid.”
  24. Yawn BP, Yawn RA. The estimated cost of school scoliosis screening. Spine (Phila Pa 1976). 2000 Sep 15;25(18):2387-91. doi: 10.1097/00007632-200009150-00019. PMID: 10984793. “Case-finding costs for screening were $24.66 per child screened (n = 2197), $3, 386.25 per child with a curve of 20 degrees or more (n = 16) and $10, 836.00 per child treated for scoliosis (n = 5).”
  25. Koukourakis I, Giaourakis G, Kouvidis G, Kivernitakis E, Blazos J, Koukourakis M. Screening school children for scoliosis on the island of Crete. J Spinal Disord. 1997 Dec;10(6):527-31. PMID: 9438820.
  26. Soucacos PN, Soucacos PK, Zacharis KC, Beris AE, Xenakis TA. School-screening for scoliosis. A prospective epidemiological study in northwestern and central Greece. J Bone Joint Surg Am. 1997 Oct;79(10):1498-503. doi: 10.2106/00004623-199710000-00006. PMID: 9378735.
  27. Yong F, Wong HK, Chow KY. Prevalence of adolescent idiopathic scoliosis among female school children in Singapore. Ann Acad Med Singap. 2009 Dec;38(12):1056-63. PMID: 20052440. “...Conclusions: The study showed a significant increase in the prevalence rates of scoliosis in the 10- to 11-year-old female students and again a significant increase in the prevalence rates in the 12- to 13-year-old female students... it was recommended that screening for females be performed every year commencing at 10 years old (Primary 5) until 13 years old (Secondary 2).”
  28. Grivas TB, Vasiliadis E, Savvidou OD, Triantafyllopoulos G. What a school screening program could contribute in clinical research of idiopathic scoliosis aetiology. Disabil Rehabil. 2008;30(10):752-62. doi: 10.1080/09638280802041086. PMID: 18432433. “...Scoliosis school screening (SSS) programs have clinically benefited many children through early detection and treatment...SSS should be adopted by policy makers, because its scope goes beyond the identification of IS at an early stage, contributing significantly into the research for IS aetiology. “
  29. Ohtsuka Y, Yamagata M, Arai S, Kitahara H, Minami S. School screening for scoliosis by the Chiba University Medical School screening program. Results of 1.24 million students over an 8-year period. Spine (Phila Pa 1976). 1988 Nov;13(11):1251-7. doi: 10.1097/00007632-198811000-00008. PMID: 3206283."...The incidence of scoliosis of more than 15 degrees increased linearly according to age from the fifth grade primary school children (0.07% in boys, 0.44% in girls) to the second grade junior high school students (0.25% in boys, 1.77% in girls). The female predominance of scoliosis cases with curvatures of more than 20 degrees detected during the total period was 10:1 and this female predominance was the same for primary school children and junior high school students....This study establishes that screening for scoliosis by the CUMS screening program is cost-effective with a low risk of radiation hazards."

Established Early-Detection Diagnostic Methods/Tools:

The following is a curated list.

Note: The 'Adams Forward Bend Test', AFBT, also referred to as the 'Forward Bend Test' FBT, the Scoliometer and Moire Topography (Japan) have been are widely used for decades. AFBT has been controversial, garnering criticism for causing over referrals because of the low positivity and specificity rates. The scoliometer, an inexpensive hand-held device, similar to a carpenter's level, measures the angle of trunk rotation and is placed on the patient's back while they are in the forward bend position. The “AAOS, SRS, POSNA, and AAP believe that effective screening programs must have well trained screening personnel who can utilize forward bending tests and scoliometer measurements to correctly identify and appropriately refer individuals with AIS for further investigation “ from Position Statement Screening for the Early Detection of Idiopathic Scoliosis in Adolescents

  1. Xiao B, Zhang Y, Yan K, Jiang J, Ma C, Xing Y, Liu B, Tian W. Where should Scoliometer and EOS Imaging be Applied when Evaluating Spinal Rotation in Adolescent Idiopathic Scoliosis -A Preliminary Study with Reference to CT Images. Global Spine J. 2024 Mar;14(2):577-582. doi: 10.1177/21925682221116824. Epub 2022 Aug 5. PMID: 35929422; PMCID: PMC10802522.
  2. Labecka MK, Plandowska M. Moiré topography as a screening and diagnostic tool-A systematic review. PLoS One. 2021 Dec 2;16(12):e0260858. doi: 10.1371/journal.pone.0260858. PMID: 34855885; PMCID: PMC8639098.
  3. Ma HH, Tai CL, Chen LH, Niu CC, Chen WJ, Lai PL. Application of two-parameter scoliometer values for predicting scoliotic Cobb angle. Biomed Eng Online. 2017 Dec 4;16(1):136. doi: 10.1186/s12938-017-0427-7. PMID: 29202876; PMCID: PMC5716015.
  4. Labelle H, Richards SB, De Kleuver M, Grivas TB, Luk KD, Wong HK, Thometz J, Beauséjour M, Turgeon I, Fong DY. Screening for adolescent idiopathic scoliosis: an information statement by the scoliosis research society international task force. Scoliosis. 2013 Oct 31;8:17. doi: 10.1186/1748-7161-8-17. PMID: 24171910; PMCID: PMC3835138. “The scoliometer is currently the best tool available for scoliosis screening and there is moderate evidence to recommend referral with values between 5 degrees and 7 degrees.”
  5. Coelho DM, Bonagamba GH, Oliveira AS. Scoliometer measurements of patients with idiopathic scoliosis. Braz J Phys Ther. 2013 Mar-Apr;17(2):179-84. doi: 10.1590/S1413-35552012005000081. PMID: 23778766. “...Conclusions: The scoliometer measurements showed a good correlation with the radiographic measurements.”
  6. Karachalios T, Sofianos J, Roidis N, Sapkas G, Korres D, Nikolopoulos K. Ten-year follow-up evaluation of a school screening program for scoliosis. Is the forward-bending test an accurate diagnostic criterion for the screening of scoliosis? Spine (Phila Pa 1976). 1999 Nov 15;24(22):2318-24. doi: 10.1097/00007632-199911150-00006. PMID: 10586455. “The Adams forward-bending test cannot be considered a safe diagnostic criterion for the early detection of scoliosis (especially when it is used as the only screening tool) because it results in an unacceptable number of false-negative findings...”

Developing and Recent Digital Screening, Wearable Devices & Monitoring Tools for AIS:

The following is a brief curated list.

  1. Taylor Liu, Andrew Tice, Jessica Romeo, Kevin Smit, Detecting and monitoring scoliosis without radiography: validating the use of Momentum Spine artificial intelligence against gold standard radiographic imaging. Canadian Journal of Surgery Vol. 68 (6 Suppl 3) December 12, 2025 (page 75) DOI: 10.1503/cjs.020125, Abstract ID 85 Program Code P188 From the Children’s Hospital of Eastern Ontario, Ottawa, Ont., "..Results: Paired t test results of all scans demonstrated that mean Momentum Spine main curve Cobb angle differed by an average of 6.72° compared with the radiographic measurement (MAI 26.8 ± 12.7° v. Mradiograph 33.5 ± 14.2°). Despite this difference being statistically significant, (–6.72°, 95% confidence interval [CI] –8.19° to –5.26°; t127 = 9.09, p < 0.0001), it falls within the accepted range for interrater variability of approximately 7° between clinicians. In the population with follow-up, post hoc analysis showed that agreement between AI-predicted Cobb angle and radiographic measurement improved to an average difference of 4.05° (AI 24.24 ± 13.4° v. radiograph 28.29 ± 14.0°; p = 0.6788). Conclusion: Momentum Spine can estimate Cobb angles within the accepted range of interrater variability between clinicians when compared with same-day radiographic Cobb angles. Therefore, it can be used to detect and monitor adolescent idiopathic scoliosis remotely."
  2. Rohde MS, Albarran M, Catanzano AA Jr, Sachs EJ, Naz H, Jobanputra A, Ribet J, Tileston K, Vorhies JS. Smartphone-based surface topography app accurately detects clinically significant scoliosis. Spine Deform. 2025 Jul;13(4):1051-1057. doi: 10.1007/s43390-025-01062-7. Epub 2025 Apr 2. PMID: 40172834; PMCID: PMC12227481."Purpose The purpose of this study was twofold: (1) to validate the predictive capabilities of the Scoliosis Assessment App using ST technology against X-ray “ground truth” in patients being evaluated for clinically significant scoliosis; and (2) to compare the diagnostic accuracy of the App versus the commonly used scoliometer tool....Conclusion: The Scoliosis Assessment App using ST technology offers an accurate, accessible, and non-ionizing method of detecting clinically significant scoliosis, suggesting that the App can be used for detection and monitoring as an alternative to radiography and as a replacement for scoliometer without diminishing the standard of care. Further studies are required to assess variations of sensitivity in a large cohort of patients and clinical utility as an alternative to radiographs."
  3. Oquendo Y, Hollyer I, Maschhoff C, Calderon C, DeBaun M, Langner J, Javier N, Bryson X, Richey A, Naz H, Tileston K, Gardner M, Vorhies JS. Mobile device-based 3D scanning is superior to scoliometer in assessment of adolescent idiopathic scoliosis. Spine Deform. 2025 Mar;13(2):529-537. doi: 10.1007/s43390-024-01007-6. Epub 2024 Dec 12. Erratum in: Spine Deform. 2025 Jul;13(4):1287. doi: 10.1007/s43390-025-01046-7. PMID: 39663336; PMCID: PMC11893700.
  4. Fazeli Veisari, S., Bidari, S., Barati, K., Atlasi, R., & Komeili, A. Wearable Devices in Scoliosis Treatment: A Scoping Review of Innovations and Challenges. Bioengineering, 12(7) 2025, 696. https://doi.org/10.3390/bioengineering12070696 "...This manuscript provides a scoping review of the classification and application of wearable devices and the role of artificial intelligence (AI) in interpreting the data collected by wearable devices and guiding the treatment....The literature shows that the use of wearable devices can enhance scoliosis treatment by improving the efficiency of braces and enabling remote monitoring in rehabilitation programs. However, more research is needed to evaluate user compliance, long-term effectiveness, and the need for personalized interventions. Future advancements in artificial intelligence, microsensor technology, and data analytics may enhance the efficacy of these devices, which can lead to more personalized and accessible scoliosis treatment...."
  5. Marjolaine Roy-Beaudry, Marie Beauséjour, Rachelle Imbeault, Justin Dufresne, Stefan Parent, New artificial intelligence–driven surface topography phone app helps screen patients with spinal deformity: early results from one institution. Canadian Journal of Surgery Vol. 67 (6 Suppl 1) November 13, 2024 (page 5) doi: 10.1503/cjs.011424, CPSS-08, Abstract ID 66 , CHU Sainte-Justine, Montréal, Que, "...Methods A single-centre observational study was conducted in the outpatient scoliosis clinic. One hundred and twenty-five patients with confirmed or suspected scoliosis were recruited... two 3D surface topography scans (upright and bent forward positions) were performed on an Apple iPhone 12. ... Validity and reproducibility of the app’s Cobb angle predictions were compared to radiographic measurements....The algorithm predicted Cobb angle (below 50°) with overall correlation of 0.89 and mean average error of 6.2°. The app screened for AIS (10° threshold) with a sensitivity of 0.92, specificity of 0.75 and area under the curve (AUC) of 0.94. At 25°, the threshold for the initiation of brace interventions, a sensitivity of 0.71, specificity of 0.90 and angle under the curve of 0.97 were noted; at 50° (surgical threshold), the values were 0.50, 1.00 and 0.94, respectively. Conclusion The implementation of 3D topography combined with AI seems of improve the accuracy of classic surface topography to predict scoliotic Cobb angle. The app’s availability on smartphones facilitates frequent at-home remote monitoring of scoliotic deformities to avoid unnecessary hospital visits and spinal x-rays, potentially detecting early curve progression as well."
  6. * Momentum Spine: A Digital Health Platform for Remotely Monitoring Spinal Deformities. A digital APP for smart phones to scan a patient's body for 3D surface topography for AIS early-detection and screening, allows for remote monitoring with care team. For patients and health care providers. Approved by Health Canada as a Class 1 Medical Device & has FDA clearance (Note: 10/24 presently under study in three major Canadian Paedeatric Hospitals and in the US at Los Angeles 03/24/25 Cedars-Sinai Guerin Children's AI Enhances Scoliosis Monitoring for Pediatric Patients (Update: 12/29/25 - Subject of studies (1, 5) above.)
  7. He Z, Lu N, Chen Y, Chun-Sing Chui E, Liu Z, Qin X, Li J, Wang S, Yang J, Wang Z, Wang Y, Qiu Y, Yuk-Wai Lee W, Chun-Yiu Cheng J, Yang KG, Yiu-Chung Lau A, Liu X, Chen X, Li WJ, Zhu Z. Conditional generative adversarial network-assisted system for radiation-free evaluation of scoliosis using a single smartphone photograph: a model development and validation study. EClinicalMedicine. 2024 Aug 16;75:102779. doi: 10.1016/j.eclinm.2024.102779. PMID: 39252864; PMCID: PMC11381623.
  8. Zhang T, Zhu C, Zhao Y, Zhao M, Wang Z, Song R, Meng N, Sial A, Diwan A, Liu J, Cheung JPY. Deep Learning Model to Classify and Monitor Idiopathic Scoliosis in Adolescents Using a Single Smartphone Photograph. JAMA Netw Open. 2023 Aug 1;6(8):e2330617. doi: 10.1001/jamanetworkopen.2023.30617. PMID: 37610748; PMCID: PMC10448299.
  9. Suresh S, Perera P, Izatt MT, Labrom RD, Askin GN, Little JP. Development and validation of a semi-automated measurement tool for calculating consistent and reliable surface metrics describing cosmesis in Adolescent Idiopathic Scoliosis. Sci Rep. 2023 Apr 5;13(1):5574. doi: 10.1038/s41598-023-32614-4. PMID: 37019938; PMCID: PMC10076386.
  10. Bottino L, Settino M, Promenzio L, Cannataro M. Scoliosis Management through Apps and Software Tools. Int J Environ Res Public Health. 2023 Apr 14;20(8):5520. doi: 10.3390/ijerph20085520. PMID: 37107802; PMCID: PMC10138677.
  11. Beauséjour M, Aubin D, Fortin C, N'dongo Sangaré M, Carignan M, Roy-Beaudry M, Martinez C, Bourassa N, Jourdain N, Labelle P, Labelle H. Parents can reliably and accurately detect trunk asymmetry using an inclinometer smartphone app. BMC Musculoskelet Disord. 2022 Aug 5;23(1):752. doi: 10.1186/s12891-022-05611-3. PMID: 35932044; PMCID: PMC9354306. (note, inclinometer is another name for scoliometer )
  12. Naziri Q, Detolla J, Hayes W, Burekhovich S, Merola A, Akamnanu C, Paulino CB. A Systematic Review of All Smart Phone Applications Specifically Aimed for Use as a Scoliosis Screening Tool. J Long Term Eff Med Implants. 2018;28(1):25-30. doi: 10.1615/JLongTermEffMedImplants.2017020737. PMID: 29772989.” Our data show that available smart phone applications can be used effectively and that, in a controlled environment, some applications performed better than a traditional scoliometer. Application price was not correlated with effectiveness; the cost-free application performed better than the for-purchase application. “

Diagnostic Imaging for Monitoring AIS:

The following is a brief curated list that includes research studies.

  1. Rachelle Imbeault, Justin Dufresne, Stefan Parent, Sylvain Deschênes, Marjolaine Roy-Beaudry, Evaluation of biplane radiographic systems for scoliotic patients Canadian Journal of Surgery Vol. 68 (6 Suppl 3) (page 2)December 12, 2025 DOI: 10.1503/cjs.020125, Abstract ID 99, Program Code CPSS02, Faculté de médecine de l’Université de Montréal, Montréal, Que.; the Centre hospitalier Universitaire Sainte-Justine, Montréal, Que.; the Université de Montréal, Montréal, Que.,"Background: Our objective was to compare the difference of radiation dose at skin entrance between 2 biplane imaging systems used for the evaluation of scoliotic deformities. One biplane imaging system emits a stable dose during the entire acquisition, while the other is using dose modulation. Image quality produced by the 2 systems will then be evaluated by 2 orthopedic surgeons to ensure that they are of diagnostic quality...Conclusion: Results indicate that dose modulation can reduce patient exposure to radiation by 48% while maintaining diagnostic image quality. The greater reduction in the cervicothoracic region suggests better protection of the radiosensitive organs located in this area."
  2. Ayesha Hadi, Dorothy J. Kim, Andrea S. Doria, Farzad Khalvati, Chaojun Chen, Jennifer A. Dermott, David E. Lebel. Enhancing accuracy of adolescent idiopathic scoliosis diagnosis in community radiology: machine learning versus manual measurement of Cobb angles. Canadian Journal of Surgery Vol. 68 (6 Suppl 3) December 12, 2025 (page 74) DOI: 10.1503/cjs.020125, Abstract ID 41 Program Code P185, the Children’s Hospital of Eastern Ontario, Ottawa, Ont.; The Hospital for Sick Children, Toronto, Ont., "Background: Approximately 25% of the measurement variation made by community radiology can be attributed to error. Inaccuracies between community radiology and tertiary care may have a significant impact on the timely presentation of adolescent idiopathic scoliosis patients. The study objective was to evaluate the effectiveness of a machine learning (ML) model to quantify curve magnitude on community-acquired spine radiographs and to subsequently identify adolescent idiopathic scoliosis patients with moderate and severe deformity for triage. Methods: A retrospective review of adolescent idiopathic scoliosis patients (n = 116) at a tertiary-care pediatric hospital with community-acquired spine radiographs was conducted. ..Conclusion: There was greater reliability of the Cobb angle readings obtained by the ML model compared with manual measurements obtained by community radiologists. There may be important clinical utility of an ML model to enhance measurements obtained in the community, which may expedite appropriate referrals to tertiary care."
  3. Ćuković S, Luković V, Zou Y, Kaiser M, Bertsch M, Heidt C, Studer D, Farshad M, Laux C. Advancing 3D idiopathic scoliosis assessment through optical scans and web-based integration - Validation of the ScolioSIM system. Comput Biol Med. 2025 Sep;196(Pt A):110735. doi: 10.1016/j.compbiomed.2025.110735. Epub 2025 Jul 9. PMID: 40639013.
  4. Kato S, Maeda Y, Nagura T, Nakamura M, Watanabe K. Comparison of three artificial intelligence algorithms for automatic cobb angle measurement using teaching data specific to three disease groups. Sci Rep. 2024 Aug 3;14(1):17989. doi: 10.1038/s41598-024-68937-z. PMID: 39097613; PMCID: PMC11297987.
  5. Wong J, Reformat M, Parent E, Lou E. Validity and accuracy of automatic cobb angle measurement on 3D spinal ultrasonographs for children with adolescent idiopathic scoliosis: SOSORT 2024 award winner. Eur Spine J. 2025 May;34(5):1622-1630. doi: 10.1007/s00586-024-08376-6. Epub 2024 Jul 10. PMID: 38987512."... imaging with radiography exposes these children to ionizing radiation, which increases their risk of developing cancer later in life...Ultrasonography is an alternative imaging method that does not emit ionizing radiation and provides depth information, allowing for 3D spinal reconstructions...Additionally, ultrasound systems have lower costs and are more portable than radiography systems....measuring scoliotic parameters on ultrasonographs is time-consuming and requires more training and leveraging the 3D views. Consequently, these obstacles create a barrier to entry for integrating ultrasonography in scoliosis clinics...Conclusion.An automatic measurement algorithm based on machine learning was developed for the coronal curve angle on 3D ultrasonographs.The developed method achieved good reliability when compared with manual ultrasound measurements, but only moderate reliability when compared with manual radiographic measurements. With measurements being made in 36 s on average and images being output displaying how the measurements are obtained, the algorithm can be integrated into clinics to at least automate coronal curve angle measurement steps. In turn, this could increase the accessibility of ultrasound AIS diagnosis. However, further improvements may be required to produce a fully automatic measurement method that is clinically feasible."
  6. Kumar S, Awadhiya B, Ratnakumar R, Thalengala A, Areeckal AS, Nanjappa Y . A Review of 3D Modalities Used for the Diagnosis of Scoliosis. Tomography. 2024 Aug 2;10(8):1192-1204. doi: 10.3390/tomography10080090. PMID: 39195725; PMCID: PMC11360202.
  7. Kaiser M, Mudavamkunnel M, Bertsch M, Laux CJ, Unterfrauner I, Wanivenhaus F, Bauer DE, Jentzsch T, Stauffer A, Farshad M, Cukovic S. Investigating the relationship between internal spinal alignment and back shape in patients with scoliosis using PCdare: A comparative, reliability and validation study. PLoS One. 2025 Jul 14;20(7):e0321429. doi: 10.1371/journal.pone.0321429. PMID: 40658701; PMCID: PMC12258602.
  8. Kwan CK, Young JH, Lai JC, Lai KK, Yang KG, Hung AL, Chu WC, Lau AY, Lee TY, Cheng JC, Zheng YP, Lam TP. Three-dimensional (3D) ultrasound imaging for quantitative assessment of frontal cobb angles in patients with idiopathic scoliosis - a systematic review and meta-analysis. BMC Musculoskelet Disord. 2025 Mar 5;26(1):222. doi: 10.1186/s12891-025-08467-5. PMID: 40045341; PMCID: PMC11881507.
  9. Pizones J, Moreno-Manzanaro L, Pupak A, Núñez-Pereira S, Larrieu D, Boissiere L, Richner-Wunderlin S, Loibl M, Zulemyan T, Yücekul A, Zgheib S, Charles YP, Chang DG, Kleinstueck F, Obeid I, Alanay A, Sánchez Pérez-Grueso FJ, Pellisé F, Reliability of a New Digital Tool for Photographic Analysis in Quantifying Body Asymmetry in Scoliosis. J Clin Med. 2024 Apr 5;13(7):2114. doi: 10.3390/jcm13072114. PMID: 38610880; PMCID: PMC11012662. "...Conclusion: We developed a new digital tool integrated into an online platform demonstrating excellent reliability and inter- and intra-observer variabilities for quantifying body asymmetry in scoliosis patients from a simple clinical photograph. The method could be used for assessing and monitoring scoliosis and body asymmetry without radiation...."
  10. Wong JC, Reformat MZ, Parent EC, Stampe KP, Southon Hryniuk SC, Lou EH. Validation of an artificial intelligence-based method to automate Cobb angle measurement on spinal radiographs of children with adolescent idiopathic scoliosis. Eur J Phys Rehabil Med. 2023 Aug;59(4):535-542. doi: 10.23736/S1973-9087.23.08091-7. PMID: 37746786; PMCID: PMC10548476. "...CONCLUSIONS An AI-based algorithm was developed to measure the Cobb angle automatically on radiographs and yielded reliable measurements quickly. The algorithm provides detailed images on how the angles were measured, providing interpretability that can give clinicians confidence in the measurements....CLINICAL REHABILITATION IMPACT Employing the algorithm in practice could streamline clinical workflow and optimize measurement accuracy and speed in order to inform AIS treatment decisions..."
  11. Ng SY, Bettany-Saltikov J. Imaging in the Diagnosis and Monitoring of Children with Idiopathic Scoliosis. Open Orthop J. 2017 Dec 29;11:1500-1520. doi: 10.2174/1874325001711011500. PMID: 29399226; PMCID: PMC5759132."Abstract:...The different imaging methods have their limitations. The EOS® stereoradiography is expensive and is not commonly available. The surface topography does not enable measurement of Cobb angle, particularly when the patient is in-brace. The 3D ultrasound scanning has inherent intrinsic technical limitation and cannot be used in all subjects. Radiography, however, enables diagnosis and monitoring of the adolescent idiopathic scoliosis (AIS). It is thus the gold standard in the evaluation and management of scoliosis curves."
  12. David Malfair, Anne K. Flemming, Marcel F. Dvorak, Peter L. Munk, Alexandra T. Vertinsky, Manraj K. Heran, and Doug A. Graeb, Radiographic Evaluation of Scoliosis: Review AJR Am J Roentgenol. 2010 Mar;194(3 Suppl):S8-22. doi: 10.2214/AJR.07.7145. PMID: 20173177.




Contact: CSSC@scoliosiscanada.ca




(Disclaimer: The non-profit Canadian Scoliosis Screening Coalition (CSSC) does not endorse any treatments, procedures, products, or health professionals referenced herein and referenced on our social media posts and in our webinars. This website's content and all referenced herein including content on our social media posts and in our webinars, is for information and educational purposes only and does not represent medical advice. CSSC is not responsible for material from linked sites and presence of such a link does not constitute an endorsement by CSSC of material on the linked site.)

    ©2025CanadianScoliosisScreeningCoalition       ©2026CanadianScoliosisScreeningCoalition