Children with mild scoliosis have traditionally all been treated in a manner whereby the amount of surveillance increases as their condition worsens, which may mean several visits with a specialist per year and x-rays to track the progression. This time and these resources may now be focused on those who are more likely to progress. Axial Biotech recently developed the SCOLISCORE Test, a DNA analysis designed to predict a patient's risk of scoliosis progression. The test is being marketed by DePuy Spine.
Kenneth Ward, MD, chief scientific officer of Axial Biotech, recently co-authored a study that showed SCOLISCORE was 99 percent accurate in predicting when children with scoliosis were least likely to progress to a severe curve. Dr. Ward discusses the study and implications that SCOLICORE has on scoliosis research in the future.
Q: SCOLISCORE produced very accurate results for patients who were at a low risk of developing severe scoliosis. How did the numbers match up for patients who were at the medium or higher risk?
Dr. Kenneth Ward: The score matches up very well for all of the patients. When a patient has a curve in the spine, he or she is given a score from 1-200 to predict the potential for curvature progression. Most people have a low risk (a score from 1-25). Fifty percent of patients have a score under 20 and 75 percent of patients have a score under 50. The risk of progression for the surgical intervention grows exponentially with the score. Somebody with a score of 200 is more than ten times as likely to have surgery for scoliosis as somebody with a score of 100.
Q: What are the clinical benefits of detecting the risk of scoliosis progression in children?
KW: If you don't have a way to test whether a patient's scoliosis has a high risk of progressing, how do you customize patient care? With the SCOLISCORE Test, we proved that patients with low-risk scores often do not develop progressive scoliosis, which means surgeons can determine a more appropriate treatment path. Kids with intermediate risk should be seeing a scoliosis specialist. Kids with high scores should also see a specialist. There are a number of minimally invasive surgical devices under development for that group of kids, including tethering and vertebral staples.
The biggest benefit comes for the low-risk group because right now, you have a lot of clinical activity directed at these patients who don't have a progressive disease. Low-risk patients are taking the time to make several visits to their surgeons and receive several x-rays. There can be a cost benefit savings of up to $10,000 per case when low-risk patients are identified because of the lengthening of time between office visits and the smaller number of x-rays done for low-risk kids.
Q: Many orthopedic and spine surgeons suggest all children are screened for scoliosis, but many schools don't provide these tests. How does having SCOLISCORE available affect school screenings for childhood scoliosis?
KW: School screening has been controversial in the U.S. because there wasn't an adequate follow-up test for surgeons to use. A federal advisory group said that school screenings shouldn't be routine because of the anxiety created by the diagnosis of mild scoliosis. The worry was that we were 'medicalizing' a lot of teenagers' lives and we were not seeing benefits from the majority of teens. We designed this test to make sure we give the attention to the right group of kids. Scoliscore testing creates a new paradigm for screening.
For now, we are still in the early evaluation stage of the studies. We are at a very good place because we've been able to prove the value of the test. The study builds upon our research on 10,000 other patients, so our confidence is getting high as to what the test is telling us.
Q: What are the long-term implications of SCOLISCORE on treatment for scoliosis?
KW: Beyond the SCOLISCORE Test, I think one of the most exciting things is that these genetic markers are the starting point to understanding the chemistry that is causing scoliosis progression. People have wondered for years whether the source of progression was in the collagen, neurological or bony structures or the biomechanics of the spine. This test gets at the chemistry of what is going on — the proteins that are causing the progressions. That could lead to unanticipated ways to prevent or control the progression.
Many therapies and implants could be developed now that would lessen the chance of progression in high-risk individuals. Sometimes the treatments are very simple once you start to understand them on a molecular level. If you give patients the treatment, you can completely change what their genes are saying is supposed to happen. We're still a long ways off from that, but it starts by discovering that genes are involved.
Learn more about SCOLISCORE.
Read other coverage on scoliosis treatment:
-Performing Minimally Invasive Surgery for Adult Scoliosis: Q&A With Dr. Neel Anand of Cedars-Sinai Medical Center in Los Angeles
- Improving Scoliosis Treatment: Q&A With Vincent Arlet, Developer of Scolisoft Scoliosis Database
Kenneth Ward, MD, chief scientific officer of Axial Biotech, recently co-authored a study that showed SCOLISCORE was 99 percent accurate in predicting when children with scoliosis were least likely to progress to a severe curve. Dr. Ward discusses the study and implications that SCOLICORE has on scoliosis research in the future.
Q: SCOLISCORE produced very accurate results for patients who were at a low risk of developing severe scoliosis. How did the numbers match up for patients who were at the medium or higher risk?
Dr. Kenneth Ward: The score matches up very well for all of the patients. When a patient has a curve in the spine, he or she is given a score from 1-200 to predict the potential for curvature progression. Most people have a low risk (a score from 1-25). Fifty percent of patients have a score under 20 and 75 percent of patients have a score under 50. The risk of progression for the surgical intervention grows exponentially with the score. Somebody with a score of 200 is more than ten times as likely to have surgery for scoliosis as somebody with a score of 100.
Q: What are the clinical benefits of detecting the risk of scoliosis progression in children?
KW: If you don't have a way to test whether a patient's scoliosis has a high risk of progressing, how do you customize patient care? With the SCOLISCORE Test, we proved that patients with low-risk scores often do not develop progressive scoliosis, which means surgeons can determine a more appropriate treatment path. Kids with intermediate risk should be seeing a scoliosis specialist. Kids with high scores should also see a specialist. There are a number of minimally invasive surgical devices under development for that group of kids, including tethering and vertebral staples.
The biggest benefit comes for the low-risk group because right now, you have a lot of clinical activity directed at these patients who don't have a progressive disease. Low-risk patients are taking the time to make several visits to their surgeons and receive several x-rays. There can be a cost benefit savings of up to $10,000 per case when low-risk patients are identified because of the lengthening of time between office visits and the smaller number of x-rays done for low-risk kids.
Q: Many orthopedic and spine surgeons suggest all children are screened for scoliosis, but many schools don't provide these tests. How does having SCOLISCORE available affect school screenings for childhood scoliosis?
KW: School screening has been controversial in the U.S. because there wasn't an adequate follow-up test for surgeons to use. A federal advisory group said that school screenings shouldn't be routine because of the anxiety created by the diagnosis of mild scoliosis. The worry was that we were 'medicalizing' a lot of teenagers' lives and we were not seeing benefits from the majority of teens. We designed this test to make sure we give the attention to the right group of kids. Scoliscore testing creates a new paradigm for screening.
For now, we are still in the early evaluation stage of the studies. We are at a very good place because we've been able to prove the value of the test. The study builds upon our research on 10,000 other patients, so our confidence is getting high as to what the test is telling us.
Q: What are the long-term implications of SCOLISCORE on treatment for scoliosis?
KW: Beyond the SCOLISCORE Test, I think one of the most exciting things is that these genetic markers are the starting point to understanding the chemistry that is causing scoliosis progression. People have wondered for years whether the source of progression was in the collagen, neurological or bony structures or the biomechanics of the spine. This test gets at the chemistry of what is going on — the proteins that are causing the progressions. That could lead to unanticipated ways to prevent or control the progression.
Many therapies and implants could be developed now that would lessen the chance of progression in high-risk individuals. Sometimes the treatments are very simple once you start to understand them on a molecular level. If you give patients the treatment, you can completely change what their genes are saying is supposed to happen. We're still a long ways off from that, but it starts by discovering that genes are involved.
Learn more about SCOLISCORE.
Read other coverage on scoliosis treatment:
-Performing Minimally Invasive Surgery for Adult Scoliosis: Q&A With Dr. Neel Anand of Cedars-Sinai Medical Center in Los Angeles
- Improving Scoliosis Treatment: Q&A With Vincent Arlet, Developer of Scolisoft Scoliosis Database