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THE RIB EPIPHYSIS AND
OTHER GROWTH CENTERS AS AN INDICATOR OF SPINAL GROWTH
Stanley Hoppenfeld, M.D.;
Baron S. Lonner, M.D.;
Vasantha Murthy, M.D.
Capping of the iliac crest has been typically used as an indicator of
the end of spinal growth for the female patient. The authors have found
this to be an unreliable marker for the end of growth. The decision to
wean a patient with idiopathic scoliosis from a brace depends on the accurate
determination of skeletal maturity. The purpose of this study was to determine
the relationship of closure of the rib epiphysis, the proximal humeral
physis, and capping and fusion of the iliac apophysis to growth cessation.
The authors also set out to determine the role of these clinical markers
in treatment of patients undergoing bracing for idiopathic scoliosis.
A cohort of 101 patients with idiopathic scoliosis undergoing brace treatment
were studied. All patients were followed to skeletal maturity and were
followed at 4 mos. intervals. Serial height measurements and age at closure
of the growth centers were recorded. Curve magnitude was recorded at the
onset of bracing, at the time of weaning, and at the time of latest follow–up.
Patients were followed for a minimum of 24 mos following the termination
of bracing.
In virtually all patients, growth as measured by standing height, continued
after capping of the iliac apophysis (Risser 4). This held true for female
as well as male subjects. Growth cessation had occurred in every patient
if one or all of the growth centers had closed completely. Typically,
skeletal maturity was reached approximately 3–6 mos. prior to final closure
of the growth centers but well after capping of the iliac apophysis.
We conclude that capping of the iliac apophysis is not a reliable indicator
of skeletal maturity and should not be used as a sign for weaning of patients
from a brace. The closure of the rib epiphysis and proximal humerus or
fusion of the iliac apophysis do indicate the end of growth and in our
opinion should be used in conjunction with serial height measurements
for decision–making in the patient who is being braced.
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