Adolescent idiopathic scoliosis (AIS) defines a spinal deformity of unknown cause with a prevalence of 2-4% and most often presents in young females aged 10 to 12 years. Treatment of scoliosis is determined by the severity of the curvature. Typically, brace treatment is initiated after a lateral curve of at least 20–25 degrees is detected in immature patients. Subsequent progression of the curve to magnitudes greater than 40–45 degrees will entail the suggestion of a surgical intervention in selected patients.
Early detection of scoliotic deformities remains controversial on the premise that the ultimate goal of reducing surgical intervention is curtailed by disputes surrounding the effectiveness of early treatment methods such as bracing. Subsequently, the United States have limited school screening programs while Canada has discontinued such efforts [1]. In 2010, the Scoliosis Research Society (SRS) formed an international task force mandated to analytically explore the merit of scoliosis screening programs. These efforts led to the consensus that scoliosis screening is recommended as a valuable tool to detect deformities of Cobb angles 10 degrees or greater which should be referred for diagnostic evaluations [2]. Speaking to early treatment effectiveness, the SRS task force also point out that level I evidence now exists to support brace treatment in AIS as a result of the recently published BrAIST multicenter NIH trial [3]. Consequently, this study is now an important feature in advocating for the adoption of early detection of scoliosis through the assessment of the angle of trunk inclination.
The gold standard of AIS screening is to use a Scoliometer (Orthopedic Systems Inc., Hayward, CA) in combination with an Adams Forward bending test to detect trunkal asymmetry as portrayed through the measured angle of trunk inclination (ATI). The Scoliometer is a medical device providing a measure of inclination derived from the relative calibrated position of an air bubble traveling within a vial of encased liquid. The SRS task force suggested that a measure between 5 and 7 degrees be used as the screening threshold while evaluation be performed for females twice at 10 and 12 years of age and once for males 13 or 14 years of age [4].
Scoliosis screening programs are conventionally reserved to health care professionals and are not widely practiced. This is perhaps related to general lack of knowledge of the public as well as the Scoliometer being focused as a clinical tool. Today’s technological advancements have integrated inclinometers into smartphones which enable them to effectively take measures of inclination, similar to the Scoliometer. Currently, several smartphone applications, otherwise known as Apps, suggest to provide measures of ATI. However, the smartphones enabling these Apps lack several characteristics of the Scoliometer and have not been validated as providing reliable clinical measures. Two physical characteristics may impede measures of ATI taken with a smartphone. First, a smartphone is not wide enough to span the ribs of the patient from which the ATI measure is derived. Second, the smartphone is not adapted to conform to the protrusion provided by the spinal process of the patient. Consequently, the widespread convenience of using one’s smartphone as a scoliosis screening tool has an appeal that inspired the development of the Scolioscreen (Spinologics Inc., Montreal, Canada).The Scolioscreen was developed as a medical device to be used in combination with a smartphone to screen for scoliosis (Figure 1). The Scolioscreen is made from a medical grade thermoplastic rubber and sized to effectively hold all smartphones, with or without a protective case, and designed to mimic the undersurface of a Scoliometer. In theory, the Scolioscreen would offer a much more accessible and convenient means to screen for and monitor scoliosis, in line with newer technologies developed for smartphones. However, in order to confidently advocate the performance of the Scolioscreen, its intra- and inter-observer reliability and accuracy as compared to the gold standard, the Scoliometer, was required. Thus the purpose of the study was to evaluate the efficacy of the Scolioscreen-smartphone combination and smartphone alone as compared to the Scoliometer. Furthermore, to encourage the widespread adoption of this medical tool, the study was performed by spine surgeons, a nurse, and the parent of the presenting patient.