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    DNA Test Predicts Scoliosis Progression

    Genetic Markers Help Predict Low-Risk Patients, but Test Has Its Limits
    WebMD Health News
    Reviewed by Laura J. Martin, MD

    Dec. 1, 2010 -- A new DNA test is accurate at predicting which children are least likely to have their scoliosis -- an abnormal curvature of the spine -- progress to a severe curvature, according to new research.

    Doing so can save medical expenses as well as unneeded X-rays and time off work for parents, says researcher Kenneth Ward, MD, chief scientific officer of Axial Biotech Inc., in Salt Lake City, which developed the test.

    X-rays can quantify the current degree of curvature, but predicting which curvature will progress isn't always easily done, Ward says.

    ''This test is the first to start to give that reassurance of who is at low risk," he tells WebMD.

    The research is published online in the journal Spine.

    Scoliosis: Predicting Progression

    Scoliosis affects up to 4% of teens, Ward writes.

    If the curvature progresses too much, the first step is often spinal bracing, needed by up to 10% of people with the condition.

    If the curvature continues to worsen, spinal fusion is often recommended.

    Scoliosis: The Test

    Ward and his colleagues evaluated 697 patients, aged 9 to 13, who had mild, moderate, or severe scoliosis.

    Of the 697:

    • 277 were low-risk girls, representing a group that was screened
    • 257 were higher-risk girls, being followed at referral centers
    • 163 were high-risk boys

    The researchers obtained saliva samples and analyzed the DNA.

    The test evaluates 53 genetic markers that are associated with scoliosis progression. It takes into account the patient's current spinal curvature, what doctors call the Cobb angle. (When the Cobb angle is greater than 45 degrees, the scoliosis is considered severe.)

    ''We do a test for each of these 53 markers," Ward says. He compares these 53 markers to 53 ''high-risk cards" dealt by one's genetics. "Severe forms of scoliosis are quite genetic," he says.

    The analysis produces a score between 1 and 200. "The higher the score, the more 'bad cards' the child was dealt," he says.

    The score represents a patient's risk for developing a severe spinal curve.

    A score or 50 or lower is low risk, 51 to 180 intermediate, and 181 to 200 high risk.

    Ward found that the test, called Scoliscore, has a 99% accuracy rate in identifying low-risk patients -- those least likely to progress to a curvature of 40 degrees or more.

    ''For the low-risk patients, it predicts less than a one in 200 chance they will end up progressing to need surgery," he says. That's overall for the low-risk group, he says; the lower the score in that low-risk category, the lower the chances.

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