Correlation of Risser sign, radiographs of hand and wrist with the histological grade of iliac crest apophysis in girls with adolescent idiopathic scoliosis.

STUDY DESIGN: A correlation analysis between histologic grade (HG) of iliac crest apophysis and skeletal age assessments. OBJECTIVE: To study the correlation between HGs of iliac crest apophysis and the skeletal age of hand and wrist, digital skeletal age (DSA), and Risser sign in the girls with adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA: The evaluation of the remaining growth of the patients clinically and radiologically is highly significant in predicting the curve progression and thus influencing the treatment strategy in AIS. METHODS: Fifty-three AIS girls with a mean age of 14.0 years undergoing corrective posterior spinal surgery and instrumentation with autogenous bone graft were recruited. Menarche status was recorded while the skeletal age of hand and wrist, DSA, and Risser grade were evaluated radiologically. Using a standardized HG of proliferative chondrocyte zone of the iliac crest apophysis, correlation between the HGs and the radiologic and clinical skeletal maturity parameters was analyzed. RESULTS: The HGs were negatively correlated with the radiologic parameters with the highest correlation coefficient between HGs and skeletal age of hand and wrist. The negative correlation between HGs and the 2 clinical parameters was significant and could be enhanced by combining with the radiologic parameters. No proliferative chondrocyte zone of the apophysis was detected when patients were either over 16 years of skeletal age or Risser grade 5, as well as 2-year postmenarche or over 15 years of chronological age in patients with DSA stage III and Risser grade 4. CONCLUSION: Radiologic skeletal age of the wrist and digits can provide important information for maturity assessment in girls with AIS. It can also enhance the sensitivity of clinical parameters in determining the remaining growth potential.

[Digital skeletal age and histological evaluation for residual spine growth potential in idiopathic scoliosis].

OBJECTIVE: To ascertain the correlation between histological grades (HGs) of vertebral growth plates and Risser grades in idiopathic scoliosis (IS) patients; to identify whether digital skeletal age (DSA) is a reliable indicator for accurate evaluation of the spinal residual growth potential. METHODS: Twenty eight Chinese female patients were available for this study. Superior and inferior growth plates were obtained at each level when anterior approach surgeries were performed. Histological examinations were conducted after the specimens were processed. The patients were evaluated by DSA stages in this study. Correlations between histological grades, menarchal status, and chronological age were analyzed. RESULTS: There was a negative correlation between the following: HGs and DSA stages in 28 cases (r = -0.541, P = 0.003), and HGs and menarchal status in patients in DSA stage III (r = -0.591, P = 0.006). Statistical significance of growth activity of growth plates was found between patients in DSA-stage II and those in DSA-stage III (P = 0.014). CONCLUSIONS: DSA may be a reliable indicator for predicting the spinal residual growth potential in IS patients, but it should be correlated with menarchal status and chronological ages.

[Assessment of the residual spine growth potential in idiopathic scoliosis by risser sign and histological grading].

OBJECTIVE: To investigate the correlation between histological grade (HG) of vertebral growth plates and Risser grade in the female idiopathic scoliosis (IS) patients; and to identify whether Risser grading is a reliable indicator for accurate evaluation of the spinal residual growth potential. METHODS: Thirty-nine samples of vertebral growth plates obtained during operation from 15 females IS patients, all female, aged 15.1 (12.4 - 18.0), underwent HE staining and light microscopy to determine the values of HG. Xray photography of pelvis was conducted before operation to identify the Risser sign. The correlation of Risser grade with pubertal status was analyzed. RESULTS: All the vertebral growth plates of the IS patients with the Risser grade of 0 showed growth activity. The vertebral growth plates showed HG II activity in 6 of the 16 IS patients with the Risser grade of 4. All the vertebral growth plates showed no growth activity in the 3 IS patients with the Risser grade of 5. There was a negative correlation between the HG and Risser grade in all 39 patients (r = -0.645, P =0.000). The HG of the patients with the Risser grade of 4 was negatively correlated with the menarchal status (time between menarche and operation) (r = -0.710, P = 0.002). The residual growth potential of spinal growth plates of the patients with the Risser grades of 2 - 5 was significantly lower than of the patients with the Risser grades of 0 - 1 (P = 0.020). CONCLUSION: Risser sign may be a reliable indicator for predicting the spinal residual growth potential in IS patients, but it should be correlated with menarchal status and chronological ages.

[Computerized tomographic study about the effect of neurocentral cartilage on the etio-pathogenesis of adolescent idiopathic scoliosis].

OBJECTIVE: To analysis the potential effect of neurocentral cartilage (NCC) on the etiology of adolescent idiopathic scoliosis (AIS). METHODS: Thirty patients with AIS (Group A) and 30 control subject with normal spine (Group B) were included in this study. The age is matched. Both groups were divided into two subgroups according to the age and each subgroup has 15 patients. The younger patients were put into subgroup A1, B1 and the older patients put into subgroup A2, B2. Computed tomography (CT) scanning was carried and the pedicle length, the angle composed by pedicle and vertebral midline (alpha) and the angle composed by NCC and vertebral midline (beta) at periapical vertebrae (T7-T10) were analyzed. RESULTS: The pedicle length showed no significant difference between group A and group B or between subgroup A1 and A2 or between B1 and B2. In each subgroup, no significant difference was found in alpha angle or beta angle between left side and right side (concave side and convex side). CONCLUSIONS: No significant pedicle growth has been found during pubertal both in AIS and normal patients. Few affect of neurocentral cartilage on the etiology of AIS has been found, which might because of low growth activity of NCC during puberty.

[Vitamin D receptor gene polymorphisms in female adolescent idiopathic scoliosis patients].

OBJECTIVE: To investigate the association of vitamin D receptor (VDR) gene polymorphisms with abnormal growth pattern and low bone mass in adolescent idiopathic scoliosis (AIS) patients. METHODS: Peripheral blood samples were obtained from 164 female patients with AIS, aged 14.4 +/- 2 (9 - 20), and 122 age-matched healthy girls. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique was used to detect the VDR gene distributions. RESULTS: The frequency of Bb genotype was significantly higher in the AIS patients than in the controls (P < 0.01). The frequency of B alleles of the AIS patients was significantly higher than that of the controls (P < 0.01). In AIS patients, the expression rate of Aa genotype of the AIS patients with the body mass index (BMI) > or = 18 kg/m(2) was significantly higher than those with the BMI < 18 kg/m(2) (P < 0.05), and the expression rate of Bb genotype of the AIS patients with the BMI < 18 kg/m(2) and arm span < 160 cm was significantly higher than that of the AIS patients with the BMI > or = 18 kg/m(2) and arm span > or = 160 cm (P < 0.05). CONCLUSION: The BsmI site polymorphism of vitamin D receptor gene may be associated with abnormal growth pattern and low bone mass in girls with AIS.

[Association between circulating leptin level and anthropometric parameters in girls with adolescent idiopathic scoliosis].

OBJECTIVE: To investigate the correlation between the circulating leptin level and the anthropometric parameters and parameters related to pubertal growth, and to explore the role of leptin in the abnormal growth pattern in girls with adolescent idiopathic scoliosis (AIS). METHODS: One hundred and twenty AIS girls selected randomly from the out-patient and in-patient departments, divided into 2 groups: Group A1 (n = 73, aged 10 - 13) and Group A2 (n = 47, aged 14 - 17), and 80 14 - 17 year-old healthy girl students receiving physical examination underwent measurement of body height and weight. Body mass index (BMI) was calculated. Peripheral fasting blood samples were collected to detect the level of leptin. The anthropometric data, pubertal status, and circulating leptin level were compared between the AIS girls and the controls. The relationships between leptin and age, menstrual status, body weight, height, BMI and Risser sign were analyzed in the AIS girls. RESULTS: Eighty-eight AIS girls (73%) and 14 healthy girls (18%) had a BMI score less than 18.0. The mean leptin level of Group A1 was 6.2 microg/L, significantly lower than of Group A2 (8.6 microg/L, P = 0.024). Compared with the healthy controls, the AIS girls had significantly greater corrected height (162.7 cm vs. 160.2 cm, P = 0.026), lower weight (44.3 kg vs. 53.6 kg, P = 0.01), lower BMI (17.5 kg/m(2) vs. 20.9 kg/m(2), P = 0.01), and lower circulating leptin (8.6 microg/L vs. 14.9 microg/L), even after the adjustment for age and menstrual status. An inverse correlation was observed between the leptin level and the age at menarche (AIS, r = -0.428, P < 0.001; controls, r = -0.280, P = 0.013). Whereas, positive correlations were found between leptin and age, menstrual status, body weight, height, BMI, and Risser sign (r = 0.234 - 0.506, P = 0.01 - < 0.001). CONCLUSION: AIS girls have markedly decreased circulating leptin level. Circulating leptin level is associated with body weight, BMI, and other growth parameters, suggesting that leptin may play an important role in the lower body mass in AIS girls.

[The value of parameters in predicting the growth peak height velocity of the adolescent idiopathic scoliosis girls: a histomorphological study on iliac crest cartilage].

OBJECTIVE: To evaluate the value of some parameters in predicting of growth peak height velocity (PHV) of the girls with adolescent idiopathic scoliosis (AIS) by histomorphological studying on iliac crest cartilage. METHODS: Iliac crest cartilages were harvested during posterior surgery from girls with AIS. The samples were then paraffin embedded after stored in formalin solid over 24 hours, sectioned vertical to the calcification at the thickness of 5 microm, and stained with Hematoxylin and Eosin. The histological grading of the proliferating activity of it was observed under the microscope. Parameters included chronologic age, menarche status, wrist skeletal age, digital skeletal age, elbow epiphysis and Risser sign were recorded. The histological grading data were compared with these parameters in terms of their accuracy in the prediction of PHV of the scoliosis. RESULTS: The specimens of 53 AIS patients with an average age 14.0 years were stained successfully. The proliferating activity of the iliac crest cartilage decreased when the AIS girl was over 13.0 years of chronologic age, 14.0 years of wrist skeletal age, post menarche or Risser sign was no less than grade 3. CONCLUSIONS: All the parameters evaluated can be used to show the end of PHV. Three parameters, including 11 years old of chronologic age, 12 years of the wrist skeletal age, unfusion of the elbow epiphysis and the thelarche, can be used in predicting the beginning of PHV.