1. Hong Zhang, M.D. and Daniel J. Sucato, M.D., MS.
Curve Progression in Girls with Idiopathic Scoliosis During Juvenile through Adolescent Periods
Hong Zhang, M.D. and Daniel J. Sucato, M.D., MS.
10th ICEOS, November 17-18, 2016, Utrecht Holland

2. Objective
To evaluate the stage of the triradiate cartilage (TRC) and Risser sign and determine their relationship to scoliosis progression during the juvenile and adolescent period in idiopathic scoliosis.

3. Methods
Thirty-six girls with juvenile idiopathic scoliosis (JIS) were retrospectively evaluated with serial spinal radiographs.
Mean age was 8.1 ± 1.6 years old.
The average follow-up was 4.8 years from the time of the initial evaluation.

4. Methods The TRC stage was defined as 3 stages:
The Risser stage was measured in the standard manner from grade 0 to 5.
The stage of the TRC and Risser were correlated with curve progression.
Open
Complete non-fused remnant.
Closing
Incomplete non-fused remnant
Closed
Complete closure

5. Results TRC Stage and Age TRC Open TRC Closing TRC Closed Age
(Years Old)
< 10.1 ± 1.3
10.5 ± 1.1
12.3 ± 0.9

6. TRC Stage and Curve Progression
Results
TRC Stage and Curve Progression
TRC Open
TRC Closing
p Value
Curve Progression
(Degree per Month)
-0.4 ± 1.7
0.8 ± 0.8
0.0094

7. Results Risser Stage and Age Risser Zero Risser 1 Risser 3 Age
(Years Old)
< 12.2 ± 1.1
12.7 ± 0.8
14.8 ± 0.9

8. Risser Stage and Curve Progression
Results
Risser Stage and Curve Progression
Risser Zero
Risser 1 - 2
p Value
Curve Progression
(Degree per month)
0.4 ± 0.6
1.3 ± 0.8
<0.0001

9. Results TRC Closing Vs. Risser 1-2 TRC Closing Risser 1 - 2 p Value
Curve Progression
(Degree per month)
0.8 ± 0.8
1.3 ± 0.8
0.0004

10. Case Example* Open TRC, Risser 0 Closing TRC Closed TRC, Risser 1-3
5.9 yo
9.9 yo
10.6 yo
11.2 yo
12.8 yo
13.3 yo
13.8 yo
14.8 yo
Open TRC, Risser 0
Closing TRC
Closed TRC, Risser 1-3
*The female patient had received Boston brace treatment for 3.5 years from 11.3 years old to 14.8 years old. The T1-S1 length increased 13.5 cm in 9 years from 5.9 to 14.8 years old.

11. Cobb (°) Years Old 70 Main Thoracic Curve Lumbar Curve 60 50 40 30 20
Risser 4 50
Risser 3 40
Risser 2
Cobb (°) 30
TRC Closed
Risser 1 20
TRC Closing
Risser 0
TRC Open
Risser 0 10 5 6 7 8 9 10 11 12 13 14 15
Years Old

12. Conclusions
Curves associated with a closing TRC and Risser 1-2 progressed significantly greater than did curves associated with an open TRC and Risser 0 in the female patients with JIS.
The progressive spurt of the curve in the juvenile – adolescent idiopathic scoliosis is in the status of the closing TRC and the Risser 1-2 grades.