SCOM - Pediatric and Adolescent Spine Growth and Maturity

What is the most common type of scoliosis?

adolescent idiopathic scoliosis (AIS)

The goal of scoliosis bracing is to correct the curve. True or false?

false - goal is to maintain the curve where it is (prevent progression)

What is normal birth size influenced by?

materal health

nutrition

placental health

Nutrition drives rapid, early infantile growth. Therefore, malnutrition can lead to diminished .

stature

Childhood growth from 3 years old until puberty is primarily driven by what hormones?

growth hormone (GH)

insulin-like growth factor-1 (IGF-1)

thyroid hormone

What marks discontinuity from childhood growth?

puberty

Bones grow in length at the .

epiphyseal plate (growth plate)

What grows in response to skeletal stimuli?

muscles

ligaments

nerves

blood vessels

If muscles, ligaments, nerves, and blood vessels respond to skeletal growth in a typical child, what happens if there is an underlying pathology?

deformity

muscular imbalance/weakness/contracture

neuropathologies

etc.

At what age does puberty start in girls and boys, and how much do they grow a year?

girls: ~10 years old (8 +/- 1 cm/yr)

boys: ~12 years old (9 +/- 1 cm/yr)

What are the two primary periods of rapid growth?

first few years of life (nutrition driven)

adolescent growth spurt (puberty)

What is peak height velocity (PHV)?

the period of time in which an adolescent experiences the fastest upward growth in their stature

aka peak growth age, maximum height growth rate, growth spurt

At what age does PHV start in girls and boys?

girls: ~12 years old

boys: ~14 years old

both ~2 years into puberty

Why is PHV important when considering scoliosis?

PHV is the major marker of growth

spine and curve grow as the child grows

curve can increase significantly and worsen curve

Puberty typically lasts how long?

~4 years

girls: ~10-14

boys: ~12-16

What is the general pattern of height growth through the years?

1: very rapid growth

2-3: gradual slowing

4-adolescence: steady velocity ~5cm/yr

small mid-childhood growth spurt @ 8

puberty

What is skeletal maturity?

maturity fully reached by official end of puberty

most definitively determined in retrospect

can determine with x-rays and height

predictor of how likely a scoliotic cure is to progress

predictor of surgical intervention

determines timing/cessation of orthotic intervention

What is the most important dimension for musculoskeletal care?

longitudinal bone growth

Longitudinal bone growth is best reflected by what measure?

PHV

PHV is easy to calculate. True or false?

false - difficult to calculate

Aside from longitudinal bone growth, what other dimensions of maturity are important to consider?

musculoskeletal development/strength

secondary sexual characteristics:

-sweat gland maturation

-voice change

-axillary hair

-facial hair

-menarche

What three methods are typically used to examine skeletal maturity?

1. Risser sign

2. Triradiate cartilage

3. Sanders scale (hand)

less common options include:

-ossification of rib heads

-cervical spine appearance

-knee

-foot

-calcaneal apophysis

-elbow

-proximal humeral epiphysis

What does the Risser sign measure?

how much mature bone has developed on the top part of the iliac apophysis (growth plate on iliac crest)

How is the Risser sign determined and interpreted?

Risser = 0: PHV not reached

Risser >0: PHV has been reached

0: 0% ossification (no line)

1: 25% ossification

2: 50% ossification

3: 75% ossification

4: 100% ossification

5: full fusion to ilium (no line)

In what direction does growth progress on the iliac crests?

grows from the outside in

fuses from the inside out

What is the triradiate cartilage?

Y-shaped epiphyseal plate that occurs at the junction where the ischium, ilium, and pubis meet in the skeletally immature skeleton

At what age does the triradiate cartilage close in girls and boys?

girls: ~12 years old

boys: ~14 years old

about the time of PHV

Typically the triradiate cartilage closes before the Risser begins. True or false?

true (when triradiate cartilage is open, R = 0)

Why did the Sanders scale develop?

recent research found looking @ growth plates in hand is more accurate way of determining remaining growth

What describes each classification of the Sanders scale?

1: growth plate more narrow than phalanx

2: growth plate same width/wider than phalanx, but not capped

3: phalanx capped by growth plate

4: growth plate fused with distal phalanx

5: full fusion of distal phalanges

6: fusion of middle/proximal phalanges

7: only distal radius open

8: distal radius has completely fused

What is the last bone to fuse in the hand?

radius

What hand is analyzed with the Sanders scale?

left hand

Why is the Sanders scale a more accurate measure of growth stage?

captures more information

lots of information and details

Risser only captures end stages

triradiate cartilage is binary (open/closed)

The Sanders scale is a stronger predictor than the Risser sign. True or false?

true

At what Sanders stage does PHV typically begin?

3

At what Sanders stage does the triradiate cartilage typically close?

5

At what Sanders stage is there full fusion of the Risser sign (5)?

8