spinecor brace

[dianek]

Hi I am new to this but I have a daughter that is 16 years old and has scoliosis she has a 37 and 45 degree curve . I am waiting to get a appoitment with the orthopidic and see what they have to say . But in the mean time I am checking into the spinecore brace and was wounder if anyone on the form that is 16 or older and is having luck with spinecore brace . or any luck stories. LOOKING FOR HELP!! Diane

[txmarinemom]

Diane, what is her Risser? Is she skeletally mature?

[christine2]

Hi Diane

From what I understand the Spinecor works best on young paitients with smaller curves. I have read about people using it for pain management for older people. If I were in your shoes I would talk directly to Dr Rivard in Montreal, he is the "real deal" and can be trusted to tell you what you need to know.

[dianek]

spinecore brace

I don't know if she is skeletally mature yet. I guess the ortho. will tell me that . Don't think I am stupid but what is the risser. I have the xray report and they don't mention that all it says is t4 is 37 degrees and t9 is 44 degrees.

[dianek]

Do you have a contact number for Dr. Rivard.

[Pooka1]

There are no stupid questions.

This site has a good illustration and explanation...

http://www.aafp.org/afp/20020501/1817.html

" Risser sign is defined by the amount of calcification present in the iliac apophysis and measures the progressive ossification from anterolaterally to posteromedially. A Risser grade of 1 signifies up to 25 percent ossific ation of the iliac apophysis, proceeding to grade 4, which signifies 100 percent ossification (Figure 1). A Risser grade of 5 means the iliac apophysis has fused to the iliac crest after 100 percent ossification. Children usually progress from a Risser grade 1 to a grade 5 over a two-year period. One study8 found that immature patients (Risser grades 0 and 1) with a spinal curvature measuring 20 to 29 degrees had a 68 percent probability of progression of 6 degrees or more during remaining growth. Patients closer to maturity (Risser grades 2 to 4) and with the same degree of scoliosis had a 23 percent probability of progression.8 Curves measuring 5 to 19 degrees in immature patients had a 22 percent probability of progression, while small curves in mature patients had only a 1.6 percent probability of progression.8

If other clinical markers of maturity such as Tanner staging or age at menarche are not consistent with the Risser grade, curve progression may proceed at a different rate. Thus, multiple measures of maturity are important to the clinical assessment of these patients."

[Pooka1]

The Risser score is not on the x-ray.

You would need to ask the doctor explicitly what the Risser is. Hopefully, he will point to the top of the iliac crest and show you how far the calcification has progressed and associate that with a number from 1 to 5.

That's what our surgeon does anyway.

[txmarinemom]

... Don't think I am stupid but what is the risser. I have the xray report and they don't mention that all it says is t4 is 37 degrees and t9 is 44 degrees.

The Risser sign marks remaining growth adolescent girls.

Remaining growth is determined by a side facing x-ray of an area of hip (the apophysis of the iliac crest). The x-rays are done to determine bone growth (ossification) in this area.

The Risser grade begins at 0 (indicating no ossification has occurred). The lower the Risser grade, the more growth remaining.

Risser grades 1, 2, 3 and 4 incrementally indicate a 25% ossification of the iliac crest.

Risser grade 5 is skeletal maturity.

If you want to see the areas they examine, and how they actually grade 1-4, here's an excellent example.

Please don't feel stupid.

Regards,
Pam

[christine2]

The # for the Spinecor clinic @ Sainte Justines Hospital is 514-345-4839

[concerned dad]

Regarding Risser, Does anyone have information concerning how reliable this measure of skeletal growth is?

I know this measure is used to assess likelihood of curve progression. Goldberg (Spine 2001 - in a controlled retrospective study) made the observation that menarche is a better measure of likelihood of curve progression than Risser.

My daughter is 14 yrs, 5'6" 38 degree Cobb and I am told she is Risser 0. However, she is post menarche.

I asked an orthopod (not "our orthopod") about this and he felt that Risser was not the best indicator of skeletal maturity, he said x-rays of the hands or wrists were better. But since the iliac crest is observable on Scolio x-rays it has been adopted as a useful measure.

The link Pam posted shows that the progression from 0-5 is rapid, so I guess my daughters situation may not be unique.

I sure would feel better though if she had a higher Risser. I do have her digital xrays and the software to view them (and measure angles, change contrasts - pretty cool) but I do not see anything to make me question the Risser 0 her orthopod assigned. (Of course, if there were a little ossification, I would feel better about my guess of just what I was looking for).
So I guess my question is: Risser 0 and post menarche? Do they jibe?

[mariaf]

Hi Concerned Dad,

I have heard other parents say that their daughters were both post menarche and Risser 0.

I guess the question becomes which of the two more accurately indicate that growth is nearly complete. I've heard that girls can grow up to 2 years post menarche. And, of course, we know that a Risser 5 is also an indication of growth being complete. So, is it that a girl stops growing at Risser 5 or (two?) years post menarche? or perhaps whichever comes first??

Certainly an interesting subject and I'm sorry if I didn't help answer it! I basically just wanted to say that I don't think your daughter's situaiton is that rare as I have heard of this before.

What does your orthopod say? (just curious)

Best of luck to you. Your daughter is lucky to have such a "concerned dad"

[Pooka1]

My daughter Willow was told she would have to wear the brace until two years after menarche irrespective of Risser. Of course that scenario entails the brace actually working which it is not for her.

[WNCmom]

Concerned dad:

You might also google Tanner Stage. I have read it is also a factor in growth rate/skeletal maturity. It is measured by signs of puberty--genital development, pubic hair, voice change in boys, etc.

[Pooka1]

I read a paper that concluded something called Tanner-Whitehouse (and then some number I think) criteria proved to be the best indicator of growth remaining. Perhaps googling that hyphenated phrase would locate the reference.

And it might have been the wrist.

In re signs of puberty, that wouldn't have worked in my girls who had benign premature puberty (all but menarche and breast development) and yet their bone age (by wrist radiograph) was the same as their chronological age within measurement error. Had it been advanced, and though they were tall for their age at the time, they would have had to take hormones to avoid their growth stopping too early where they would have ended up being much shorter than average.