Scoliosis is a disease, which disfigures and distorts human body, often effecting vital organs, resulting in morbidity and even mortality in severe cases. It is defined as rotations and lateral curvatures of an individual’s spinal column. Scoliosis can be classified into 3 types — infantile (0-3 years), juvenile (4-7 years) and idiopathic (8 years and above). The last one is most common. A two-minute-orthopedic examination of children, in the age group seven- to ten-years, may alert the health-care provider to early-warning signals, provided the examination is conducted by properly trained professionals and child is barefoot and completely undressed except short underpants. The major problem is either following up children, who are not at risk (wasting human resources) or missing up checks on those who are most prone to acquiring this condition (not directing human resources at the target population). In order to resolve this issue, a mathematical index, ‘Cumulative-Scoliosis-Risk Weightage (CSRW)’ is proposed and tested on a sample population of seven- to eight-year old children studying in a local school of Karachi. This index is computed on the basis of child’s age, history of spinal deformities in family, tallness/wasting in child, Adam’s forward-bending test, plumb-line not aligned, drooping of one shoulder, scapulae uneven, midline of back C or S shaped, body triangles not equal, one of the spinal dimples at a higher level as compared to the other and moiré picture asymmetric about the sagittal plane. A high CSRW warranted differential-spinalfunction- testing before sending the child for X rays. Effective methods are the need of hour to reduce or even rule out un-required X rays, since they may be harmful to the delicate bone marrow of growing population. Differential-spinal-function testing consists of four tests — visual examinations in the standing and the sitting positions as well as forward bending tests in the standing and the sitting positions. The study was conducted (after approval from the Ethics Committee of University of Karachi) on 81 school children (28 boys; 53 girls), who were followed up for three years. Threshold values of CSRW were determined for deciding about the at-risk cases. A CSRW of 5.5 after the first check up, 6.5 after the second check up and 7.5 after the third check up, respectively, called for including the child in list of those, who should be followed up till the end of their growth periods. Results of this study indicated that girls were twice at risk for acquiring scoliosis as compared to boys.
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