Effectiveness and Cost Burden of School Screening for Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-Analysis.

STUDY

DESIGN

Systematic review and meta-analysis of school-based AIS screening programs.

OBJECTIVE

To determine the prevalence, diagnostic performance, clinical impact, and cost burden of routine school screening for adolescent idiopathic scoliosis.

BACKGROUND

The rationale for routine screening is that curves detected before skeletal maturity respond to bracing, reduce progression, and avert costly fusion, yet controversy persists regarding false positives, radiation exposure, and program affordability across health care systems.

MATERIALS AND

METHODS

Databases searched were PubMed, Embase, Scopus, Web of Science, and Cochrane Central from inception to February 2025. Inclusion criteria were asymptomatic pupils aged 10 to 16 screened at school and reporting prevalence, test accuracy, treatment, or cost. Data were pooled with random effects models, heterogeneity was assessed by I 2 , and currency was expressed as US dollars.

RESULTS

Thirty-four studies covering 2.8 million pupils met the inclusion criteria. Prevalence was 0.66% for curves over 10°, 0.33% over 20, and 0.02% over 40. Screening tests gave sensitivity 74% to 100% and specificity 80% to 99%, negative predictive value approached 100%, and positive predictive value approached 4% to 80%. Screen-detected adolescents showed a mean Cobb 28° versus 40° in usual care, with 73% lower fusion odds. Numbers needed to screen to start bracing ranged from 448 to 2234. Costs were 0.47 to 55 dollars per pupil, and most economic models predicted net savings despite heterogeneity.

CONCLUSIONS

School-based screening reliably detects AIS at milder stages, is associated with lower surgical rates, and can be economically defensible under well-designed, multistep protocols. Nevertheless, wide variations in prevalence, screening methods, and cost frameworks highlight the need for standardized programs and contemporary economic evaluations to optimize benefit while minimizing unnecessary referrals and radiation exposure.