Spinal growth and a histologic evaluation of the Risser grade in idiopathic scoliosis

Study Design. Thirty-four patients with idiopathic scoliosis who underwent anterior spinal surgery as part of the correction of spinal deformity were studied prospectively. Superior and inferior endplates were harvested and e xamined histologically for evidence of residual growth activity. This was t hen correlated with Risser grades, chronologic age, and pubertal status. Objectives. To clarify the correlation between Risser grade and vertebral e ndplate growth potential in patients with idiopathic scoliosis. Summary of Background Data. The importance of longitudinal spinal growth in patients with idiopathic scoliosis and its correlation with curve progress ion and the crankshaft phenomenon after posterior fusion are well recognize d. The Risser grade, which shows the extent of excursion of the iliac apoph ysis on serial plain radiographs, is commonly used to estimate residual spi nal growth. However, the correlation between the Risser grade and vertebral endplate growth potential in patients with idiopathic scoliosis remains un clear. Methods. Superior and inferior endplates were harvested from these patients and examined histologically for evidence of residual growth. This was corr elated with Risser grade, chronologic age, and pubertal status;. Results. R isser Grade 5 was found to be the only indicator of cessation of vertebral growth in idiopathic, scoliosis, Of the 14 patients with Risser Grade 4, 10 showed significant growth activity in the vertebral endplates. The reliabi lity of Risser Grade 4 increases when combined with chronologic age and tim e since menarche in female patients. Conclusions. The crankshaft phenomenon is reported to occur only in patient s with Risser Grade 2 or less, particularly those with open triradiate cart ilages. Our findings of significant endplate growth activity, even in patie nts with Risser Grade 4, make it unlikely that the crankshaft phenomenon is caused purely by longitudinal spinal growth.