The Rib Epiphysis and Other Growth Centers as an Indicator of Spinal Growth
Information provided by
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.
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.
Updated on: 12/10/09
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