Risser Sign Methods of Skeletal Maturity Assessment and Scoliosis
A critical component of any scoliotic treatment or management is assessing the possibility of future growth. Dr. Joseph C. Risser, an American orthopedic surgeon, developed the risser sign method to assess growth spurts objectively. His grading process was developed through intense research and is based on his collaborative work with Dr. Ferguson.
Dr. Risser related that the iliac apophysis (pelvic rim) is the best means of evaluating potential future growth. Scoliosis is a disorder the rapidly progresses, so evaluating potential future growth is very important. In scoliosis, progression is most rapid during periods of rapid growth, known as growth spurts. Through the Risser method, our chiropractors and physiotherapists can keep a close eye on our patient’s development after our scoliosis exam. Spinal curves that are at, or greater than, 25-degrees stand to worsen even more during growth spurts. Our clinical teams use the Risser skeletal maturity method of assessing x-rays before forming a treatment plan. Curves at 25-degrees or more which are given Risser signs of 1 or 2, will need a greater level of attention.
How to Calculate Skeletal Maturity with the Risser’s Method?
The most accurate means of measuring skeletal maturity is through the observation of the Risser sign on a pelvic x-ray. Dr. Risser devised his grading system to rate growth spurts on a scale of 0-5. In short, patients who are Risser 0 and one are growing rapidly, while patients who are 4 and five have stopped growing. We have provided a brief description of each grade for clarity:
- When the ilium is calcified at or close to 25%, it corresponds to early or pre-puberty and as such is given a Grade 1.
- A Risser Grade 2 is designated when the Pelvic rim (ilium) calcification process has progressed to 25-50%. It represents the stage of an active growth spurt.
- Grade 3 is when the ilium is calcified at 50-75%; it corresponds to the slowing of the growth spurt.
- The Risser Grade 4 is descriptive of slowing down of the growth spurt. In a Risser Grade 4, the calcification process of the ilium is said to be between 75-100%.
- The end of the growth spurt is graded as a 5. A Risser Grade 5 is where the iliac apophysis (ilium or pelvic rim) is fully fused, forming a single bone. Grade 5 corresponds to the end of growth; it is the stage corresponding to 100% growth.
We hope the information presented here was helpful in understating the Risser Signs for scoliosis assessment. If your child has scoliosis, the Risser method of assessing future growth is critical to the planning and management of your child’s scoliosis. Should you require any assistance, please visit one of our centers. Our clinical teams of Chiropractors and Physiotherapists can help, guide, plan, and formulate condition-specific treatments for scoliosis today.
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