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Risser sign

Indirect measure of skeletal maturity

Summary

Indirect measure of skeletal maturity

FieldValue
NamePelvis
ImageGray242.png
CaptionFemale type pelvis
Image2Gray241.png
Caption2Male type pelvis

The Risser sign is an indirect measure of skeletal maturity, whereby the degree of ossification of the iliac apophysis by x-ray evaluation is used to judge overall skeletal development. Mineralization of the iliac apophyses begins at the anterolateral crest and progresses medially towards the spine. Fusion of the calcified apophyses to the ilium then progresses in opposite direction, from medial-to-lateral.

A typical five-point grading scale is as follows:

  • Grade 1 is given when the ilium (bone) is calcified at a level of 25%; it corresponds to prepuberty or early puberty.
  • Grade 2 is given when the ilium (bone) is calcified at a level of 50%; it corresponds to the stage before or during growth spurt.
  • Grade 3 is given when the ilium (bone) is calcified at a level of 75%; it corresponds to the slowing of growth.
  • Grade 4 is given when the ilium (bone) is calcified at a level of 100%; it corresponds to an almost cessation of growth.
  • Grade 5 is given when the ilium (bone) is calcified at a level of 100% and the iliac apophysis is fused to iliac crest; it corresponds to the end of growth.

Risser grading is traditionally used to estimating the future growth potential of the adolescent spine, particularly in the setting of spinal scoliosis. Risser originally recognized that ossification of the iliac apophyses approximately parallels the ossification of the vertebral apophyses. The earlier the stage of growth, the greater the likelihood of a scoliosis progressing and potentially needing intervention. Note that although Risser first described his findings during a 1948 lecture and published the eponymous paper in 1958, formalized staging systems were developed at a later time.

Controversy

The Risser grading system has been criticized as being an inaccurate proxy for skeletal maturity. Comparison of predicted future growth and progression of scoliosis to actual measured changes show that the Risser system is variably accurate. Specifically, because the progression from stages 1 to 4 (apophyseal "excursion") is rapid and only takes an average of approximately 1 year, these stages are of limited value in pinpointing stage of growth. Cessation of trunk growth as predicted by Risser stage is also earlier than actual growth.

In 2008, Sanders et al proposed an alternative system for assessing skeletal maturity, using hand x-rays in a manner similar to "gold standards" (Greulich and Pyle, Tanner-Whitehouse-III) skeletal maturity assessments. Whether the use of the Sanders vs Risser staging for management of scoliosis would lead to different treatment decisions is being debated.

References

References

  1. (2014). "Measurements and Classifications in Musculoskeletal Radiology". Thieme.
  2. (May 2002). "Adolescent Idiopathic Scoliosis: Radiologic Decision-Making". American Family Physician.
  3. Risser JC. Important practical facts in the treatment of scoliosis. ''Instr Course Lect'' 1948;V:248-260.
  4. Risser, J. C.. (1958-01-01). "The Iliac apophysis; an invaluable sign in the management of scoliosis". Clinical Orthopaedics.
  5. (September 1994). "The Risser Sign: A Critical Analysis". Journal of Pediatric Orthopaedics.
  6. (March 2008). "Predicting scoliosis progression from skeletal maturity: a simplified classification during adolescence". The Journal of Bone and Joint Surgery. American Volume.
  7. (2018-01-22). "High Risk of Mismatch Between Sanders and Risser Staging in Adolescent Idiopathic Scoliosis: Are We Guiding Treatment Using the Wrong Classification?". Journal of Pediatric Orthopedics.
Wikipedia Source

This article was imported from Wikipedia and is available under the Creative Commons Attribution-ShareAlike 4.0 License. Content has been adapted to SurfDoc format. Original contributors can be found on the article history page.

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