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Return to New DNA Test Predicts Risk of Severe Scoliosis Overview

More on New DNA Test Predicts Risk of Severe Scoliosis

New DNA Test Predicts Risk of Severe Scoliosis

New York, NY (Oct 29, 2009)

Strand of DNA

A simple test could reinvent how scoliosis is cared for in adolescents. NewYork-Presbyterian Morgan Stanley Children's Hospital is among the first centers nationally to offer ScoliScore, a new DNA-based molecular test that helps predict the risk of spinal curve progression. The test provides doctors with information about the likelihood that an abnormal spine curve will get significantly worse or stay the same.

One hundred thousand children are diagnosed with scoliosis every year in the U.S. and must be followed on a consistent, often quarterly basis, to determine and assess disease progression. For teenagers, scoliosis has traditionally been a game of wait-and-see. Patients are observed over several years, with frequent doctors' visits and X-rays, all without knowing what their long-term outcome is likely to be. While all patients diagnosed with scoliosis are monitored and followed in the same way, less than 10 percent of patients actually progress to a severe curve.

"Molecular testing promises to be a major breakthrough for scoliosis," says Michael G. Vitale, MD, Chief of Pediatric Spine and Scoliosis Surgery at NewYork-Presbyterian Morgan Stanley Children's Hospital. "With evidence indicating whether a child's spine will continue to curve or if it will stay the same, we can better personalize care, treating the disease that much more effectively and efficiently."

What is ScoliScore?

ScoliScore, developed by Axial Biotech Inc., uses a DNA sample from the patient's saliva. Within about two weeks a report is sent to the physician with a score indicating the child's likelihood of having scoliosis that will progress. The scores are grouped into low, moderate and severe categories.

The ScoliScore test is intended for patients:

  • With a primary diagnosis of AIS
  • Between the ages of 9 and 13 years old
  • With a mild scoliotic curve (defined as <25°), or
  • With a moderate scoliotic curve (defined as >25°, but less than 40°)

"That score with about 95 percent certainty gives us a picture of progression on a scale of 0 to 200. If the score is 0, 5 or 10 then we can reassure the parents and tell them that the curve is very unlikely to progress," says Dr. Vitale. "We often will not brace a child with a very low score. It can make a very big difference.

"Because the test is so new we are trying to figure out how it changes our treatment on the other end of the spectrum," continues Dr. Vitale. "In other words, a child who has a very high score, for example 190, and we suspect the curve is almost certain to progress, we are sometimes more aggressive in treating it, particularly with some of the novel treatments like spinal stapling or growth rods."

If the test shows a patient has a high risk for serious spinal curvature of 50 degrees or more, Dr. Vitale and his colleagues can intervene earlier than they would otherwise, such as by prescribing a back brace. And since less than 10 percent of teens with scoliosis progress to the point where spinal fusion surgery is necessary, the new test can also prevent unnecessary testing. Radiation exposure from diagnostic X-rays is associated with increased risk of problems with bone and breast tissue (girls are more likely than boys to have scoliosis).

ScoliScore is currently indicated for adolescent idiopathic scoliosis. An estimated 4 percent of children between the ages of 10 and 16 have the condition, making up 80 percent of all scoliosis cases.

"'Idiopathic' means 'of unknown causes.' Since ScoliScore has shown that there is a genetic basis for the condition, we may need to consider a new name," notes Dr. Vitale, who has been involved in validating the test and is currently working with Axial Biotech to expand its use with younger children.

Molecular testing is one part of a comprehensive program of scoliosis care at NewYork-Presbyterian Morgan Stanley Children's Hospital. In addition to standard treatment options like back bracing and spinal fusion surgery, the scoliosis team now offers minimally invasive spinal stapling. Aimed at children with moderate scoliosis who are still growing, the technique has been shown to stop scoliosis from getting worse, and sometimes even correct the curve.

"We are currently pursuing our research as to the predictive value of the ScoliScore," adds Dr. Vitale. "We believe that this is something that will really change treatment practices for idiopathic scoliosis in the next couple of years."

Contributing faculty for this article:

Michael G. Vitale, MD, Chief of Pediatric Spine and Scoliosis Surgery at NewYork-Presbyterian Morgan Stanley Children's Hospital, and the Ana Lucia Associate Professor of Clinical Pediatrics and Orthopaedic Surgery at Columbia University College of Physicians and Surgeons

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