measuring maturity

[MATJESNIC]

Some of you may know that I have always wondered why Nicole was at a risser 0 even though she has her period. Well, first of all, I do not know her risser at this time because we haven't been to the ortho in 5 months. Second of all, a year ago, according to her hand x-ray, the ortho at Shriner's said she was a 0-1. The ortho in Montreal said she was a 0 based on the x-ray of her spine.

Anyway, I came across an article today from American Family Physician and I have some guarded optimism as a result. Please bear with me because I don't know how to cut and paste. The most important paragraph related to Nicole reads as follows:

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

The average female reaches a Tanner stage 1 at 11 years, the beginning of growth spurt at 11.5, a Risser grade 1 at 12 years, and has an onset of menarche between 12 and 13 (Nicole got hers a month after her 12th b-day). A female patient who matures consistent with these averages will have a relatively higher risk of curve progression before 12 years of age (she progressed rapidly between age 11 and 12) and a relatively lower risk of curve progression after 12.5 years of age. (Please dear God, let this be true for Nicole)

I hope you don't think I am grasping for straws or trying to look through a crystal ball, but this really does describe Nicole's history of growth so far.

I am choosing to be hopeful.

Hope this wasn't too boring.

[atljb2]

Thanks for the info

Melissa,

Thanks for posting that info, those are all the markers that seem to describe my daughter as well. Lets hope they ring true!

Alison
Mom to Lindsay (29T and 27L)

[Carmell]

Melissa,

I'm not sure my comments will be of any use, but maybe.

The comments you posted are consistant with what we've learned and have been told by many orthopedic surgeons. The bottom line is there are multiple factors in determining skeletal maturity - not JUST a Risser score. If it were that easy, no one would have a progressive scoliosis problem because we would all know when that spine would progress and would be able to intervene before it does.

My daughter seems to have been a year behind the stats - she started menses 3 months after her 13th bday. Her curve progressed rapidly between 12.5 and 13yrs. After that, she had a slow progression, and eventually at age 15 a stable measurement (even decreasing 5degrees, which is within the margin of error, but still). By 2 years post-menses (this is what we were told) if the patient has a thoracic curve of 40+ degrees, they have a higher risk of progressing as an adult. A smaller curve means they have a less chance of progressing. My daughter's curve is a lumbar curve. At 2yrs post-menses, she measured 35 degrees. They told her that she was in the "normal" range for being at risk for future progression (like the general public). Not sure I fully believe this, but at age 21 now, she's doing well. No progression.

Basically, this is not an exact science. Too many variables make it impossible to know if a patient will progress. No one can be 100% certain. We, as parents, can do everythin in our power to stop the progression (which isn't much) and have to know in the end that we made the right choices. You can't beat yourself up over something that is totally out of your control (within reason - I know about preventative measures, etc.).

Good luck. Try not to stress about this.

[Celia]

I was thinking the opposite, if Nicole had some growth left she would hopefully get further correction because that's usually the case with infantile and juvenile curves but I guess looking at this from a different angle of associating growth with curve progression, I could see why you're hoping for no growth. Whatever happens, I hope it's good news for Nicole!!!! *hugs*

[amandap]

Hi Melissa,

Very intresting info ~ Thanks.

I wasn't sure when you were leaving but I know Nicole has an upcoming appt. (mon?) Anyway; I just wanted to let you know she's in my prayers and I hope all is well with her.

And also have HAPPY BIRTHDAY!!! I know that's on Monday ~ I got the day off from work for your birthday (ha ha)

Let me know how everything turns out.

Amanda

[MATJESNIC]

Thanks everyone for the well wishes.

It is true that with growth there is also the chance of correction. But in Nicole's case with her big curves, everyone agrees that we are hoping she is done growing. She had some growth while in Spinecor and it didn't result in any correction. We are just hoping for stability at this point. Monday will tell us a lot.

[mariaf]

Melissa,

Again, Happy Birthday and best of luck on Monday - thanks for the day off from work due to your birthday - LOL!

[cherylplinder]

Happy Birthday, Melissa!

[MATJESNIC]

Thanks for the birthday wishes. All I want for my birthday is stability in my daughter's curves.

[cherylplinder]

Yeah, that would be the best present you could have, wouldn't it? I hope you have some fun in Montreal, too. It should be beautiful!

[flowerpower]

Happy Birthday Melissa! I really hope you get your wish! Have a great weekend.

Renee

[gerbo]

as far as i can gather, bonematurity as such is not a riskfactor, more rapid growth or the potential for rapid growth. Most girls have their major growthspurt just before their first period (or there about) which really means that once you've had your menarche, and irrespective of risser grade, risk of progression is greatly diminished, and measures you take, like wearing the spinecor, should have a better chance of keeping things under control (i.e. stable)

have a happy, happy birthday

[MATJESNIC]

Thanks all.

There will not be any time for fun in Montreal. We are basically staying over in upstate N.Y. and driving in for the appt., and driving the 7 hours home. My girls can't miss school the next day. Of course my almost-19 year old's friend told him that he is legal to drink in Montreal. But I assured Matthew there would be no time for drinking.

Gerbo,

I am glad to hear you say that. Everyone gets caught up with Risser and with girls their growth is usually related to their maturity with regard to puberty. Remember Dr. D'Andrea wouldn't even discuss stapling with us because Nicole had just had her period. Her exact words were "She doesn't have much growing left." Yet, she was at a 0/1 Risser.

[trcylynn]

Sorry to be the one to put a damper on all the positive things stated but this is my own personal experience...

Left Lumbar Curve
Age 12- diagnosed at approximately 13 degrees
Age 16 (around when I got my first period)- 15 degrees
Age 18- done growing- 19 degrees
Age 21- still done growing- 22/23 degrees
Currently- going to get xrays again but it looks like it is worse- now with rib rotation that I never had before as well as a shoulder blade problem that I never had before

When I was told once I hit puberity it should stop progressing I was extatic because I can flex my left side (the side the curve goes toward) and look semi-straight. Now the curve is so pronounced that even when I flew to stand up tall you can tell the curve is there.

I was never put in a brace though- my curve was always too minor for the doctors to do anything about it even though I kept saying I was in pain- so hopefully the brace will help it stabalize. One could say I had my own "brace" though as I would flex that side of my back throughout the entire day as I'm not a doctor I can only guess but I think if I would not have done that and let it be it would be even worse than it is now.

I hope that this is not the case with your daughter and that the doctors are right that hers will slowly stabalize.

~Tracy

[Snoopy]

Here's my two cents worth...Jamie started her period 4 months before she turned 12. She was diagnosed with a 36* curve 4 days after her 12th birthday, and was a Risser 0. By the time she tunred 13, she had progressed to 46* and was a Risser 5 at which time she had surgery. In that year's time, I think she grew about 1/2 inch.

Mary Lou