Today we're going to delve a bit deeper into this fundamental growth indicator in children and adolescents and understand the importance of the Risser sign in scoliosis and its treatment. I confess that during the time I wore a brace and went to the doctor countless times, I never heard of Risser. I learned and understood what this sign is only as an adult when I returned to study scoliosis. I was surprised to realize how important it is for doctors and physiotherapists to decide how to treat a crooked spine.
Simply put, the Risser sign is a crucial radiographic measurement for healthcare professionals treating scoliosis, as it identifies the skeletal maturity of the adolescent's iliac crest - a bony structure in the upper part of the pelvis - and, based on this, they determine the most suitable treatment for the deformity. For example, if an adolescent with scoliosis has a low Risser sign and a significant curve, the orthopedist may recommend more aggressive treatment options, such as wearing an orthopedic brace or surgery, to prevent the scoliosis curve from progressing as the patient continues to grow.
The scale ranges from 0 to 5, with the lower number indicating less ossification and therefore a higher chance of curve progression.
Risser 0: Indicates no ossification of the iliac crest.
Risser 1: Indicates initial ossification, usually starting at the lateral edge of the iliac crest.
Risser 2: Indicates more advanced ossification, usually covering about a quarter of the iliac crest.
Risser 3: Indicates ossification covering approximately half of the iliac crest.
Risser 4: Indicates ossification covering approximately three-quarters of the iliac crest.
Risser 5: Indicates complete ossification of the iliac crest, indicating skeletal growth is complete.
Healthcare professionals typically use the Risser sign as one of several factors to assess the risk of scoliosis progression in adolescents. Other factors also include the patient's age, the size and location of the scoliosis curve, and growth pattern. Generally, the lower the Risser sign (indicating less skeletal maturity), the higher the risk of scoliosis progression. Adolescents with Risser 0 or 1 have a higher risk of progression compared to those with Risser 3, 4, or 5.
When I was discharged from the Milwaukee brace, the term my doctor used was "closed growth." He gave me the good news shortly after evaluating my X-ray and seeing that my skeletal maturity was complete. Today, I know he meant that my Risser had reached 5 at the age of 14, and therefore, I could stop wearing the brace.
It is important to note that scoliosis progression is influenced by a variety of factors, and the Risser sign is just one of them. The treatment and monitoring of scoliosis should be carried out by a specialized orthopedist, who will take into consideration all relevant factors when making treatment decisions.
And you, did you already know what the Risser sign is?
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