title: A modified Risser grading system predicts the curve acceleration phase of female adolescent idiopathic scoliosis.
abstract: BACKGROUND
  The Risser sign can be assessed with the United States method or the European method. The Tanner-Whitehouse method estimates skeletal age on the basis of hand radiography and digital skeletal age. Digital skeletal age scores between 400 and 425 are associated with the beginning of the curve acceleration phase or peak growth velocity in adolescent idiopathic scoliosis. The first objective of the present study was to evaluate the agreement between the two Risser grading systems. The second objective was to identify which grading system best predicts a digital skeletal age of between 400 and 425. The third objective was to explore a new system that could be used to replace the Risser method.
  
  
  METHODS
  One hundred female patients with adolescent idiopathic scoliosis were recruited in this cross-sectional descriptive study. Each patient was evaluated with posteroanterior spine and hand radiographs. The Risser sign was measured according to both the United States and European grading systems. Digital skeletal age was calculated, and triradiate cartilage ossification was assessed.
  
  
  RESULTS
  With use of kappa statistics, moderate agreement between the United States and European grading systems was seen. Risser stages alone were not good predictors of the curve acceleration phase. A new system with three groups was tested, and the second group (Risser 0 with closed triradiate cartilage and Risser 1) was the best predictor of a digital skeletal age score of between 400 and 425.
  
  
  CONCLUSIONS
  Two Risser grading systems coexist, and the agreement between them is moderate. No Risser stage was found to be a good clinical landmark for the beginning of the curve acceleration phase of adolescent idiopathic scoliosis. A new group, Risser 0 with closed triradiate cartilage and Risser 1, was the best predictor of the beginning of the curve acceleration phase. This new system is easy to implement and is based on findings that are available on spine radiographs. It should be used at the first visit and for scoliosis follow-up to assess skeletal maturity and correlation with the curve acceleration phase.
authors.affiliation: Division of Orthopedics, Sainte-Justine Hospital, Montréal, QC, Canada. timinet@hotmail.com
authors.forename: Marie-Lyne
authors.initials: ML
authors.lastname: Nault
authors.forename: Stefan
authors.initials: S
authors.lastname: Parent
authors.forename: Philippe
authors.initials: P
authors.lastname: Phan
authors.forename: Marjolaine
authors.initials: M
authors.lastname: Roy-Beaudry
authors.forename: Hubert
authors.initials: H
authors.lastname: Labelle
authors.forename: Michèle
authors.initials: M
authors.lastname: Rivard
mesh_terms: D000293:Adolescent; D000365:Age Determination by Skeleton / Q000379:methods*; D002648:Child; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D011237:Predictive Value of Tests; D012600:Scoliosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012720:Severity of Illness Index