Modification and application of the proximal humerus ossification system to adolescent idiopathic scoliosis patients

Abstract

Purpose

We have previously demonstrated that proximal humeral ossification patterns are reliable for assessing peak height velocity in growing patients. Here, we sought to modify the system by including medial physeal closure and evaluate whether this system combined with the Cobb angle correlates with progression to surgery in patients with adolescent idiopathic scoliosis.

Methods

We reviewed 616 radiographs from 79 children in a historical collection to integrate closure of the medial physis into novel stages 3A and 3B. We then analyzed radiographs from the initial presentation of 202 patients with adolescent idiopathic scoliosis who had either undergone surgery or completed monitoring at skeletal maturity. Summary statistics for the percentage of patients who progressed to the surgical range were calculated for each category of humerus and Cobb angle.

Results

The intra-observer and inter-observer ICC for assessment of the medial physis was 0.6 and 0.8, respectively. Only 3.4% of radiographs were unable to be assessed for medial humerus closure. The medial humerus physis begins to close about 1 year prior to the lateral physis and patients with a closing medial physis, but an open lateral physis were found to be the closest to PHV (0.7 years). Stratifying patients by Cobb angle and modified humerus stage yield categories with low and high risks of progression to the surgical range.

Conclusion

The medial humerus can be accurately evaluated and integrated into a new modified proximal humerus ossification system. Patients with humerus stage 3A or below have a higher rate of progression to the surgical range than those with humerus stage 3B or above.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

Availability of data and materials

Anonymized HIPAA compliant data available for review.

Code availability

No custom code used and all analytical steps available for review.

References

  1. 1.

    Lonstein JE, Carlson JM (1984) The prediction of curve progression in untreated idiopathic scoliosis during growth. J Bone Joint Surg Am 66(7):1061–1071

    Google Scholar 

  2. 2.

    Peterson LE, Nachemson AL (1995) Prediction of progression of the curve in girls who have adolescent idiopathic scoliosis of moderate severity. Logistic regression analysis based on data from The Brace Study of the Scoliosis Research Society. J Bone Jt Surg Am 77(6):823–827.

  3. 3.

    Ylikoski M (2005) Growth and progression of adolescent idiopathic scoliosis in girls. J Pediatr Orthop B 14(5):320–324

    Google Scholar 

  4. 4.

    Sanders JO, Khoury JG, Kishan S et al (2008) Predicting scoliosis progression from skeletal maturity: a simplified classification during adolescence. J Bone Joint Surg Am 90(3):540–553

    Google Scholar 

  5. 5.

    Pyle SI, Mann AW et al (1948) A substitute for skeletal age (Todd) for clinical use; the red graph method. J Pediatr 32(2):125–136

    Google Scholar 

  6. 6.

    Pyle SI, Reed RB, Stuart HC (1959) Patterns of skeletal development in the hand. Pediatrics 24:886–903

    Google Scholar 

  7. 7.

    Pyle SI, Waterhouse AM, Greulich WW (1971) Attributes of the radiographic standard of reference for the National Health Examination Survey. Am J Phys Anthropol 35(3):331–337

    Google Scholar 

  8. 8.

    Tanner JM, Davies PS (1985) Clinical longitudinal standards for height and height velocity for North American children. J Pediatr 107(3):317–329

    Google Scholar 

  9. 9.

    Tanner JM, Whitehouse RH, Takaishi M (1966) Standards from birth to maturity for height, weight, height velocity, and weight velocity: British children, 1965. II Arch Dis Child 41(220):613–635

    Google Scholar 

  10. 10.

    Hacquebord JH, Leopold SS (2012) In brief: the risser classification: a classic tool for the clinician treating adolescent idiopathic scoliosis. Clin Orthop Relat Res 470(8):2335–2338

    Google Scholar 

  11. 11.

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

    Google Scholar 

  12. 12.

    Sanders JO, Browne RH, McConnell SJ, Margraf SA, Cooney TE, Finegold DN (2007) Maturity assessment and curve progression in girls with idiopathic scoliosis. J Bone Jt Surg Am 89(1):64–73

    Google Scholar 

  13. 13.

    Vira S, Husain Q, Jalai C et al (2017) The interobserver and intraobserver reliability of the sanders classification versus the risser stage. J Pediatr Orthop 37(4):e246–e249

    Google Scholar 

  14. 14.

    Nicholson AD, Liu RW, Sanders JO, Cooperman DR (2015) Relationship of calcaneal and iliac apophyseal ossification to peak height velocity timing in children. J Bone Jt Surg Am 97(2):147–154

    Google Scholar 

  15. 15.

    Nicholson AD, Sanders JO, Liu RW, Cooperman DR (2015) The relationship of calcaneal apophyseal ossification and Sanders hand scores to the timing of peak height velocity in adolescents. Bone Jt J 97-b(12):1710–1717.

  16. 16.

    Li DT, Cui JJ, DeVries S et al (2018) Humeral head ossification predicts peak height velocity timing and percentage of growth remaining in children. J Pediatr Orthop 38(9):e546–e550

    Google Scholar 

  17. 17.

    Nelson S, Hans MG, Broadbent BH Jr, Dean D (2000) The brush inquiry: an opportunity to investigate health outcomes in a well-characterized cohort. Am J Hum Biol Off J Hum Biol Council 12(1):1–9

    Google Scholar 

  18. 18.

    Daruwalla JS, Balasubramaniam P, Chay SO, Rajan U, Lee HP (1985) Idiopathic scoliosis. Prevalence and ethnic distribution in Singapore schoolchildren. J Bone Jt Surg Br 67(2):182–184.

  19. 19.

    Konieczny MR, Senyurt H, Krauspe R (2013) Epidemiology of adolescent idiopathic scoliosis. J Child Orthop 7(1):3–9

    Google Scholar 

  20. 20.

    Soucacos PN, Soucacos PK, Zacharis KC, Beris AE, Xenakis TA (1997) School-screening for scoliosis. A prospective epidemiological study in northwestern and central Greece. J Bone Jt Surg Am 79(10):1498–1503.

  21. 21.

    Weinstein SL (2019) The natural history of adolescent idiopathic scoliosis. J Pediatr Orthoped 39(Issue 6, Supplement 1 Suppl 1):S44-s6.

  22. 22.

    Daffner SD, Beimesch CF, Wang JC (2010) Geographic and demographic variability of cost and surgical treatment of idiopathic scoliosis. Spine (Phila Pa 1976) 35(11):1165–1169.

  23. 23.

    Yawn BP, Yawn RA (2000) The estimated cost of school scoliosis screening. Spine (Phila Pa 1976) 25(18):2387–2391.

  24. 24.

    Helenius I, Mattila M, Jalanko T (2014) Morbidity and radiographic outcomes of severe scoliosis of 90 degrees or more: a comparison of hybrid with total pedicle screw instrumentation. J Child Orthop 8(4):345–352

    Google Scholar 

  25. 25.

    Sansur CA, Smith JS, Coe JD, et al (2011) Scoliosis research society morbidity and mortality of adult scoliosis surgery. Spine (Phila Pa 1976) 36(9):E593–7.

  26. 26.

    Jackson TJ, Miller D, Nelson S, Cahill PJ, Flynn JM (2018) Two for one: a change in hand positioning during low-dose spinal stereoradiography allows for concurrent, reliable sanders skeletal maturity staging. Spine Deform 6(4):391–396.

  27. 27.

    Li DT, Linderman GC, Cui JJ et al (2019) The proximal humeral ossification system improves assessment of maturity in patients with scoliosis. J Bone Jt Surg Am 101(20):1868–1874

    Google Scholar 

Download references

Acknowledgements

We acknowledge the help of George C. Linderman Ph.D. and Yuval Kluger Ph.D. for their support in understanding the mathematics underlying our system.

Funding

We acknowledge a 2018 POSNA Start Up Research Grant that was awarded to Dr. Brian G. Smith and now transferred to Dr. Daniel R. Cooperman on “Guiding Scoliosis Evaluation with a Humeral Head Ossification Algorithm”. Studies were IRB approved.

Author information

Affiliations

Authors

Contributions

DTL: Study conception and design, measurements, statistics, drafting manuscript, review of manuscript, approval of final submission, agreement to be accountable. EL: Study design and statistical analysis, revision of manuscript, approval of final submission, agreement to be accountable. JJC: Study design and measurements, review of manuscript, approval of final submission, agreement to be accountable. JBK Data acquisition and interpretation, critical revision of manuscript, approval of final submission, agreement to be accountable. LP: Data acquisition, critical revision of manuscript, approval of final submission, agreement to be accountable. GJA: Data interpretation, critical revision of manuscript, approval of final submission, agreement to be accountable. MM: Data interpretation, critical revision of manuscript, approval of final submission, agreement to be accountable. RT: Data interpretation, critical revision of manuscript, approval of final submission, agreement to be accountable. JDG: Data acquisition, critical revision of manuscript, approval of final submission, agreement to be accountable. AMM: Data acquisition, critical revision of manuscript, approval of final submission, agreement to be accountable. AND: Data acquisition, critical revision of manuscript, approval of final submission, agreement to be accountable. EC: Data interpretation, critical revision of manuscript, approval of final submission, agreement to be accountable. DRC: Study conception and design, measurements, statistics, drafting manuscript, review of manuscript, approval of final submission, agreement to be accountable. BGS: Study conception and design, measurements, statistics, drafting manuscript, review of manuscript, approval of final submission, agreement to be accountable.

Corresponding author

Correspondence to Brian G. Smith.

Ethics declarations

Conflicts of interest

Reported by authors in COI forms.

Ethics approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Yale University approved this study.

Consent to participate

Not applicable—anonymized retrospective review.

Consent for publication

Not applicable—anonymized retrospective review.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Li, D.T., Li, E., Cui, J.J. et al. Modification and application of the proximal humerus ossification system to adolescent idiopathic scoliosis patients. Spine Deform (2021). https://doi.org/10.1007/s43390-021-00338-y

Download citation

Keywords

  • Proximal humerus ossification system
  • Adolescent idiopathic scoliosis
  • Peak growth velocity
  • Risk of progression
  • Cobb angle