Radiographic versus ultrasound evaluation of the Risser Grade in adolescent idiopathic scoliosis: a prospective study of 46 patients

Abstract

The determination of skeletal age is essential in the management of patients with scoliosis. One of the most frequently used techniques to determine skeletal maturity is the method described by Risser. However, repeated X-ray exposure in the follow-up examinations of scoliosis patients may increase the risk of cancer. We compared conventional radiological evaluation of the Risser grade with ultrasound evaluation. For scoliosis patients routine application of ultrasound in the follow-up examinations may significantly reduce radiation exposure. 46 adolescent idiopathic scoliosis patients (median age, 14.5 years) were investigated. Sonographic and radiographic assessment of Risser sign was carried out by two independent senior staff skeletal radiologists. Agreement of Risser Grade between the two diagnostic methods was determined by Kappa statistics. Coefficients <0.21, 0.21–0.40, 0.41–0.60, 0.61–0.80, and >0.80 were rated as poor, fair, moderate, good, and very good agreement. For Risser Grades I–III 100% agreement was found between the two methods. Disagreement between radiographic and sonographic evaluation was found in Risser Grades IV and V. In five patients, X-ray evaluation yielded Risser Grade V while ultrasound showed Risser Grade IV. In one patient, radiographic examination resulted in Risser Grade IV while Grade V was detected in ultrasound. Overall, the Kappa value showed very good agreement between the two diagnostic methods. Our findings suggest that ultrasound can be applied as an alternative method to X-ray evaluation in Risser Grade determination. It should be routinely used in clinical practice to reduce the patients exposure to radiation.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2

References

  1. 1.

    Adam CJIM, Harvey JR, Askin GN (2005) Variability in Cobb angle measurements using reformatted computerized tomography scans. Spine 30:1664–1669. doi:10.1097/01.brs.0000169449.68870.f8

    PubMed  Article  Google Scholar 

  2. 2.

    Altman D (1991) Practical statistics for medical research. Chapman & Hall/CRC, Boca Raton

    Google Scholar 

  3. 3.

    Bilgili YHS, Kara SA, Sanli C, Erdal HH, Altinok D (2003) Accuracy of skeletal age assessment in children from birth to 6 years of age with the ultrasonographic version of the Greulich–Pyle atlas. J Ultrasound Med 22:683–690

    PubMed  Google Scholar 

  4. 4.

    Bjerkreim ISH, Brox JI (2007) Idiopathic scoliosis treated with Cotrel-Dubousset instrumentation: evaluation 10 years after surgery. Spine 32:2103–2110. doi:10.1097/BRS.0b013e318145a54a

    PubMed  Article  Google Scholar 

  5. 5.

    Bulthuis GJVA, Nijenbanning G (2008) Clinical effect of continuous corrective force delivery in the non-operative treatment of idiopathic scoliosis: a prospective cohort study of the TriaC-brace. Eur Spine J 17:231–239. doi:10.1007/s00586-007-0513-9

    PubMed  Article  Google Scholar 

  6. 6.

    Castriota-Scanderbeg ADMV (1995) Ultrasound of femoral head cartilage: a new method of assessing bone age. Skeletal Radiol 24:217–420. doi:10.1007/BF00228922

    Article  Google Scholar 

  7. 7.

    Castriota-Scanderbeg ASM, Emberti-Gialloreti L, Fraracci L (1998) Skeletal age assessment in children and young adults: comparison between a newly developed sonographic method and conventional methods. Skeletal Radiol 27:271–277. doi:10.1007/s002560050380

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Charles YP, Canavese DA, Daures F (2007) Skeletal age assessment from the olecranon for idiopathic scoliosis at Risser Grade 0. J Bone Joint Surg Am 89:2737–2744. doi:10.2106/JBJS.G.00124

    PubMed  Article  Google Scholar 

  9. 9.

    Cheung JVA, Halbertsma JPK, Maurits NM, Sluiter WJ, Cool JC, Van Horn JR (2004) The relation between electromyography and growth velocity of the spine in the evaluation of curve progression in idiopathic scoliosis. Spine 29:1011–1016. doi:10.1097/00007632-200405010-00012

    PubMed  Article  Google Scholar 

  10. 10.

    De Smet AAFS, Asher MA (1981) A method for minimizing the radiation exposure from scoliosis radiographs. J Bone Joint Surg Am 63:156–158

    PubMed  Google Scholar 

  11. 11.

    Dolan LAWS (2007) Surgical rates after observation and bracing for adolescent idiopathic scoliosis: an evidence-based review. Spine 32:S91–S100. doi:10.1097/BRS.0b013e318134ead9

    PubMed  Article  Google Scholar 

  12. 12.

    Greulich WPS (1959) Radiographic atlas of skeletal development of the hand and wrist, 2nd edn. Stanford University Press, Stanford

    Google Scholar 

  13. 13.

    Hoffman DALJ, Morin MM, Visscher W, Harris BS 3rd, Boice JD Jr (1989) Breast cancer in women with scoliosis exposed to multiple diagnostic X-rays. J Natl Cancer Inst 81:1307–1312. doi:10.1093/jnci/81.17.1307

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Hoppenfeld SLB, Murthy V, Yun G (2003) The rip epiphysis and other growth centers as indicators of the end of spinal growth. Spine 29:47–50. doi:10.1097/01.BRS.0000103941.50129.66

    Article  Google Scholar 

  15. 15.

    Izumi Y (1995) The accuracy of Risser staging. Spine 20:1868–1871. doi:10.1097/00007632-199509000-00004

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Karol LAJC, Browne RH, Madison M (1993) Progression of the curve in boys who have idiopathic scoliosis. J Bone Joint Surg Am 75:1804–1810

    PubMed  CAS  Google Scholar 

  17. 17.

    Kim YJLL, Bridwell KH, Cheh G, Whorton J, Sides B (2007) Prospective pulmonary function comparison following posterior segmental spinal instrumentation and fusion of adolescent idiopathic scoliosis: is there a relationship between major thoracic curve correction and pulmonary function test improvement? Spine 32:2685–2693. doi:10.1097/BRS.0b013e318074c3ce

    PubMed  Article  Google Scholar 

  18. 18.

    Kohashi Y, Oga M, Sugioka Y (1996) A new method using top views of the spine to predict the progression of curves in idiopathic scoliosis during growth. Spine 21:212–217. doi:10.1097/00007632-199601150-00010

    Google Scholar 

  19. 19.

    Kotwicki TDJ, Padovani JP (2006) Correction of flexible thoracic scoliosis below 65 degrees—a radiological comparison of anterior versus posterior segmental instrumentation applied to similar curves. Eur Spine J 15:972–981. doi:10.1007/s00586-005-0991-6

    PubMed  Article  Google Scholar 

  20. 20.

    Kuklo TPB, Polly D, O’Brian F, Schroeder T, Lenke L (2005) Reliability analysis for manual adolescent idiopathic scoliosis measurements. Spine 30:444–454. doi:10.1097/01.brs.0000153702.99342.9c

    PubMed  Article  Google Scholar 

  21. 21.

    Kuklo TRPB, Schroeder TM, O’Brien MF (2006) Comparison of manual and digital measurements in adolescent idiopathic scoliosis. Spine 31:1240–1246. doi:10.1097/01.brs.0000217774.13433.a7

    PubMed  Article  Google Scholar 

  22. 22.

    Little DGSK, Katz D, Herring JA (2000) Relationship of peak height velocity to other maturity indicators in idiopathic scoliosis in girls. J Bone Joint Surg Am 82:685–693

    PubMed  CAS  Google Scholar 

  23. 23.

    Lonstein JCJ (1984) The prediction of curve progression in untreated idiopathic scoliosis during growth. J Bone Joint Surg Am 66:1061–1071

    PubMed  CAS  Google Scholar 

  24. 24.

    Mentzel HJVC, Eulenstein M, Schwartz T, Vogt S, Böttcher J, Yaniv I et al (2005) Assessment of skeletal age at the wrist in children with a new ultrasound device. Pediatr Radiol 35:429–433. doi:10.1007/s00247-004-1385-3

    PubMed  Article  Google Scholar 

  25. 25.

    Noordeen MHHF, Edgar MA, Pringle J (1999) Spinal growth and a histological evaluation of the Risser grade in idiopathic scoliosis. Spine 24:535–538. doi:10.1097/00007632-199903150-00006

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Peterson LNA (1995) Prediction of progression of the curve in girls who have adolescent idiopathic scoliosis of moderate severity. J Bone Joint Surg Am 77:823–827

    PubMed  CAS  Google Scholar 

  27. 27.

    Richards BSBR, D’Amato CR, Thompson GH (2005) Standardization of criteria for adolescent idiopathic scoliosis brace studies: SRS Committee on Bracing and Nonoperative Management. Spine 30:2068–2075. doi:10.1097/01.brs.0000178819.90239.d0

    PubMed  Article  Google Scholar 

  28. 28.

    Risser J (1958) The Iliac apophysis: an invaluable sign in the management of scoliosis. Clin Orthop Relat Res 11:111–119

    CAS  Google Scholar 

  29. 29.

    Sanders JOBR, Cooney TE, Finegold DN, McConnell SJ (2006) Correlates of the peak high velocity in girls with idiopathic scoliosis. Spine 31:2289–2295. doi:10.1097/01.brs.0000236844.41595.26

    PubMed  Article  Google Scholar 

  30. 30.

    Sanders JOBR, McConnell SJ, Margraf SA, Cooney TE (2007) Maturity assessment and curve progression in girls with idiopathic scoliosis. J Bone Joint Surg Am 89:64–73. doi:10.2106/JBJS.F.00067

    PubMed  Article  Google Scholar 

  31. 31.

    Sanders JOHJ, Brown RH (1995) Posterior arthrodesis and instrumentation in the immature spine in idiopathic scoliosis. J Bone Joint Surg Am 77:39–45

    PubMed  CAS  Google Scholar 

  32. 32.

    Sanders JOLD, Richards BS (1997) Prediction of the crankshaft phenomenon by peak height velocity. Spine 22:1352–1356. doi:10.1097/00007632-199706150-00013

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Shuren NKJ, Emans J, Rand F (1991) Reevaluation of the use of the Risser sign in idiopathic scoliosis. Spine 17:359–361. doi:10.1097/00007632-199203000-00020

    Article  Google Scholar 

  34. 34.

    Song KMLD (2000) Peak high velocity as a maturity indicator for males with idiopathic scoliosis. J Pediatr Orthop 20:286–288. doi:10.1097/00004694-200005000-00003

    PubMed  Article  CAS  Google Scholar 

  35. 35.

    Suh PBMEG (1997) Idiopathic scoliosis in males: a natural history study. Spine 22:1352–1357. doi:10.1097/00007632-199706150-00013

    Article  Google Scholar 

  36. 36.

    Wagner UADV, Schmitt O (1995) Determination of skeletal maturity by ultrasound: a preliminary report. Skeletal Radiol 24:417–420. doi:10.1007/BF00941236

    Google Scholar 

  37. 37.

    Wong HKHJ, Rajan U, Chia HP (2005) Idiopathic scoliosis in Singapore schoolchildren: a prevalence study 15 years into the screening program. Spine 30:1188–1196. doi:10.1097/01.brs.0000162280.95076.bb

    PubMed  Article  Google Scholar 

  38. 38.

    Wu JQY, Zhang L, Sun Q, Qiu X, He Y (2006) Association of estrogen receptor gene polymorphisms with susceptibility to adolescent idiopathic scoliosis. Spine 31:1131–1136. doi:10.1097/01.brs.0000216603.91330.6f

    PubMed  Article  Google Scholar 

  39. 39.

    Yrjönen TYM, Schlenzka D, Poussa M (2007) Results of brace treatment of adolescent idiopathic scoliosis in boys compared with girls: a retrospective study of 102 patients treated with the Boston brace. Eur Spine J 16:393–397. doi:10.1007/s00586-006-0167-z

    PubMed  Article  Google Scholar 

  40. 40.

    Zapussis ALJJ (1958) The iliac apophysis and the evolution of curves in scoliosis. J Bone Joint Surg Br 40:442–453

    Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Christian Bach.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Thaler, M., Kaufmann, G., Steingruber, I. et al. Radiographic versus ultrasound evaluation of the Risser Grade in adolescent idiopathic scoliosis: a prospective study of 46 patients. Eur Spine J 17, 1251–1255 (2008). https://doi.org/10.1007/s00586-008-0726-6

Download citation

Keywords

  • Skeletal age
  • Risser grade
  • Ultrasound asessment
  • Adolescent idiopathic scoliosis