New DNA Test Predicts Risk of Severe Scoliosis

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. In other words, the test provides doctors with actionable information about the likelihood that an abnormal spine curve will get significantly worse or stay the same.

For teenagers, scoliosis - a deforming disease that causes the spine to curve irregularly - has traditionally been a game of wait-and-see. Patients are observed over several years, with frequent doctor's 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 Dr. Michael Vitale, 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.

"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."

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.

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.