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.