Results 1 to 7 of 7

Thread: Growth Beyond Skeletal Maturity

  1. #1
    Join Date
    Mar 2009
    Posts
    1,090

    Growth Beyond Skeletal Maturity

    My daughter's orthopedic surgeon stated that it had been proven that kids whose curves progressed after reaching skeletal maturity were not done with their growth.

    Here are a couple of research items showing that growth can continue beyond skeletal maturity when judged by both Risser and by fusion of the epiphyses of the hand and wrist.

    These are both based on older observations, so I wonder why many orthopedic surgeons don't take this into account when determining the time to stop bracing? Is this just relying on odds, and it's just unfortunate for those kids who don't follow the average growth patterns? Shouldn't they be relying on cessation of vertical growth also?

    Spinekids has numerous kids this has happened to. Perhaps the doctors could show their patients sideshift exercises during weaning of the brace to help minimize any further progression if they feel the kid can't take bracing any more.

    Anybody have any knowledge of or insight into the reasons?


    The pathogenesis of adolescent idiopathic scoliosis
    A systematic review of the literature

    Kouwenhoven JWM
    Castelein RM

    "Contrary to the findings of Risser and Ferguson, complete ossification of the iliac apophysis did not always correlate with the cessation of vertebral growth. Several authors reported progression of scoliotic curves after skeletal maturity, diagnosed by Risser’s method."

    (This is an interesting paper, by the way, in case anyone is interested in a review of the possible causes of scoliosis).


    Spine (Phila Pa 1976). 1992 Apr;17(4):437-40.

    Growth beyond skeletal maturity.
    Howell FR, Mahood JK, Dickson RA.

    University Department of Orthopaedic Surgery, St. James's University Hospital, Leeds, United Kingdom.

    Serial measurements of standing and sitting height of children show that growth continues beyond the age of skeletal maturity when judged by the fusion of the epiphyses of the hand and wrist. Most of this increase occurs in the sitting height, largely reflecting spinal growth, and may account for the known progression potential of idiopathic scoliosis beyond the attainment of skeletal maturity.

    http://journals.lww.com/spinejournal...turity.10.aspx

  2. #2
    Join Date
    Jan 2010
    Location
    San Bruno, CA
    Posts
    271
    Quote Originally Posted by Ballet Mom View Post

    Here are a couple of research items showing that growth can continue beyond skeletal maturity when judged by both Risser and by fusion of the epiphyses of the hand and wrist.

    These are both based on older observations, so I wonder why many orthopedic surgeons don't take this into account when determining the time to stop bracing? Is this just relying on odds, and it's just unfortunate for those kids who don't follow the average growth patterns? Shouldn't they be relying on cessation of vertical growth also?

    Spinekids has numerous kids this has happened to. Perhaps the doctors could show their patients sideshift exercises during weaning of the brace to help minimize any further progression if they feel the kid can't take bracing any more.

    Anybody have any knowledge of or insight into the reasons?
    I would think scoliosis docs probably know this and would take it into account when determining brace cessation. That being said, it's a good point and certainly the research literature uses risser and/or wrist physes to determine skeletal maturity and does not make it clear that some growth can still occur.

    From a clinical perspective I think part of the reason growth is not better measured is because getting consistent results requires a lot of work and effort and even then can be highly questionable. The amount of growth shown in the second article you list is on the order of 2-4mm/year in the 2nd and 3rd year after skeletal maturity. To give you an idea of how difficult that would be to accurately measure, I worked with some 3-d motion camera projects when I first started in research. It was a fancy system called OPTOTRAK. It had infrared markers that you could tape on the skin and a camera that would pick up the location and plot/record 3-d movements in real time. The system cost ~> $100k all together. The accuracy was 0.5mm. That is, it could pin point a spot to within 1/2 a millimeter. So the ability of a nurse/clinician to measure height, weight and any of the other 14 things they have to do in order to check in a patient and get them ready to see the doctor, with the accuracy close to that of a computer that specializes in measurement accuracy, is low at best.

    So, all of that being said and to sum up... I think it's a good point and I'd think that many docs would consider that in their treatment decisions although also somewhat relying on what 'usually happens' when looking at Risser, TRC and menarche.

  3. #3
    Join Date
    Mar 2009
    Location
    Arizona
    Posts
    948

    growth after maturity

    Interestingly enough my mother grew a full inch during her 20s.

    We thought that was an anomoly... maybe not.

  4. #4
    Join Date
    Nov 2005
    Location
    SPAIN
    Posts
    63
    My daughter’s doc, asked her to wear the brace at night for several years more, due to that possible remaining growth.
    She is now 19 y.o. and has been wearing the brace only at night for 1.5 years.
    2004: Daughter diagnosed at 13 L38º. Risser 0.
    Treatment: Cheneau brace
    2009: Brace free, 18 years old, Risser 5, L25º

  5. #5
    Join Date
    Mar 2009
    Posts
    1,090
    Quote Originally Posted by AILEA View Post
    My daughter’s doc, asked her to wear the brace at night for several years more, due to that possible remaining growth.
    She is now 19 y.o. and has been wearing the brace only at night for 1.5 years.
    That's interesting Ailea, thanks for sharing that. I have to admit I've been considering postponing my daughter's next appointment with her orthopedist because I suspect she will have reached Risser 5 and the odds are that her surgeon will tell her she's done with bracing. If he says that, my daughter will never put on a brace again, and I'm quite concerned about this late growth potential. We'll see. It's something to certainly think about.

  6. #6
    Join Date
    Mar 2009
    Posts
    1,090
    Quote Originally Posted by Dingo View Post
    Interestingly enough my mother grew a full inch during her 20s.

    We thought that was an anomoly... maybe not.
    I have heard of lots of cases of young men who have had a significant growth spurt in their twenties. I can't say I've ever heard of a young woman having one. So maybe it is an interesting anomaly? :-)

    Actually, it sounds like it may not be such an anomaly if Ailea's daughter's physician is having her night bracing into her twenties.
    Last edited by Ballet Mom; 01-05-2011 at 05:34 PM.

  7. #7
    Join Date
    Mar 2009
    Posts
    1,090
    Quote Originally Posted by skevimc View Post
    I would think scoliosis docs probably know this and would take it into account when determining brace cessation. That being said, it's a good point and certainly the research literature uses risser and/or wrist physes to determine skeletal maturity and does not make it clear that some growth can still occur.

    From a clinical perspective I think part of the reason growth is not better measured is because getting consistent results requires a lot of work and effort and even then can be highly questionable. The amount of growth shown in the second article you list is on the order of 2-4mm/year in the 2nd and 3rd year after skeletal maturity. To give you an idea of how difficult that would be to accurately measure, I worked with some 3-d motion camera projects when I first started in research. It was a fancy system called OPTOTRAK. It had infrared markers that you could tape on the skin and a camera that would pick up the location and plot/record 3-d movements in real time. The system cost ~> $100k all together. The accuracy was 0.5mm. That is, it could pin point a spot to within 1/2 a millimeter. So the ability of a nurse/clinician to measure height, weight and any of the other 14 things they have to do in order to check in a patient and get them ready to see the doctor, with the accuracy close to that of a computer that specializes in measurement accuracy, is low at best.

    So, all of that being said and to sum up... I think it's a good point and I'd think that many docs would consider that in their treatment decisions although also somewhat relying on what 'usually happens' when looking at Risser, TRC and menarche.
    Thanks for the interesting information. I was just somewhat surprised when Katz et al, from Texas Scottish Rite Hospital performed their study that showed bracing was effective, chose to use the following brace discontinuation parameters:

    Brace treatment was discontinued at Risser 4 or 18 months post menarche in the girls, boys until growth ceased
    After 18 months post menarche, my daughter had a 3/4 inch growth spurt in a six-month time frame according to her orthopedist. In the study, she would have already been removed from the brace. It's amazing to me that even in a study that is trying to prove the efficacy of brace treatment, they don't try to prevent progression due to later than usual growth. Egads. Perhaps these bracing studies are still underestimating the effectiveness of bracing if used more effectively.

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •