title: Prediction of Curve Progression in Idiopathic Scoliosis: Validation of the Sanders Skeletal Maturity Staging System.
abstract: METHODS
  Retrospective case series.
  
  
  OBJECTIVE
  This study aimed to validate the Sanders Skeletal Maturity Staging System and to assess its correlation to curve progression in idiopathic scoliosis.
  
  
  BACKGROUND
  The Sanders Skeletal Maturity Staging System has been used to predict curve progression in idiopathic scoliosis. This study intended to validate that initial study with a larger sample size.
  
  
  METHODS
  We retrospectively reviewed 1100 consecutive patients with idiopathic scoliosis between 2005 and 2011. Girls aged 8 to 14 years (<2 yr postmenarche) and boys aged 10 to 16 years who had obtained at least 1 hand and spine radiograph on the same day for evaluation of skeletal age and scoliosis curve magnitude were followed to skeletal maturity (Risser stage 5 or fully capped Risser stage 4), curve progression to 50° or greater, or spinal fusion. Patients with nonidiopathic curves were excluded.
  
  
  RESULTS
  There were 161 patients: 131 girls (12.3 ± 1.2 yr) and 30 boys (13.9 ± 1.1 yr). The distribution of patients within Sanders stage (SS) 1 through 7 was 7, 28, 41, 45, 7, 31, and 2 patients, respectively; modified Lenke curve types 1 to 6 were 26, 12, 63, 5, 38, and 17 patients, respectively. All patients in SS2 with initial Cobb angles of 25° or greater progressed, and patients in SS1 and SS3 with initial Cobb angles of 35° or greater progressed. Similarly, all patients with initial Cobb angles of 40° or greater progressed except those in SS7. Conversely, none of the patients with initial Cobb angles of 15° or less or those in SS5, SS6, and SS7 with initial Cobb angles of 30° or less progressed. Predictive progression of 67%, 50%, 43%, 27%, and 60% was observed for subgroups SS1/30°, SS2/20°, SS3/30°, SS4/30°, and SS6/35° respectively.
  
  
  CONCLUSIONS
  This larger cohort shows a strong predictive correlation between SS and initial Cobb angle for probability of curve progression in idiopathic scoliosis.
  
  
  METHODS
  3.
authors.affiliation: *Department of Orthopedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE †Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA; and ‡Department of Orthopedic Surgery, University of Rochester Medical Center, Rochester, NY.
authors.forename: Prakash
authors.initials: P
authors.lastname: Sitoula
authors.forename: Kushagra
authors.initials: K
authors.lastname: Verma
authors.forename: Laurens
authors.initials: L
authors.lastname: Holmes
authors.forename: Peter G
authors.initials: PG
authors.lastname: Gabos
authors.forename: James O
authors.initials: JO
authors.lastname: Sanders
authors.forename: Petya
authors.initials: P
authors.lastname: Yorgova
authors.forename: Geraldine
authors.initials: G
authors.lastname: Neiss
authors.forename: Kenneth
authors.initials: K
authors.lastname: Rogers
authors.forename: Suken A
authors.initials: SA
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D041923:Adolescent Development; D000365:Age Determination by Skeleton; D000367:Age Factors; D002648:Child; D002657:Child Development; D018450:Disease Progression; D005260:Female; D050276:Hand Bones / Q000000981:diagnostic imaging* / Q000254:growth & development; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012600:Scoliosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012737:Sex Factors; D013131:Spine / Q000000981:diagnostic imaging* / Q000254:growth & development