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Prediction of Curve Progression in Idiopathic Scoliosis: Validation of the Sanders Skeletal Maturity Staging System

Sitoula, Prakash, MBBS, MS (Ortho)*; Verma, Kushagra, MD; Holmes, Laurens Jr, PhD, DrPH*; Gabos, Peter G., MD*,†; Sanders, James O., MD; Yorgova, Petya, MS*; Neiss, Geraldine, PhD*; Rogers, Kenneth, PhD, ATC*; Shah, Suken A., MD*,†

doi: 10.1097/BRS.0000000000000952
Deformity

Study Design. Retrospective case series.

Objective. This study aimed to validate the Sanders Skeletal Maturity Staging System and to assess its correlation to curve progression in idiopathic scoliosis.

Summary of Background Data. The Sanders Skeletal Maturity Staging System has been used to predict curve progression in idiopathic scoliosis. This study intended to validate that initial study with a larger sample size.

Methods. We retrospectively reviewed 1100 consecutive patients with idiopathic scoliosis between 2005 and 2011. Girls aged 8 to 14 years (<2 yr postmenarche) and boys aged 10 to 16 years who had obtained at least 1 hand and spine radiograph on the same day for evaluation of skeletal age and scoliosis curve magnitude were followed to skeletal maturity (Risser stage 5 or fully capped Risser stage 4), curve progression to 50° or greater, or spinal fusion. Patients with nonidiopathic curves were excluded.

Results. There were 161 patients: 131 girls (12.3 ± 1.2 yr) and 30 boys (13.9 ± 1.1 yr). The distribution of patients within Sanders stage (SS) 1 through 7 was 7, 28, 41, 45, 7, 31, and 2 patients, respectively; modified Lenke curve types 1 to 6 were 26, 12, 63, 5, 38, and 17 patients, respectively. All patients in SS2 with initial Cobb angles of 25° or greater progressed, and patients in SS1 and SS3 with initial Cobb angles of 35° or greater progressed. Similarly, all patients with initial Cobb angles of 40° or greater progressed except those in SS7. Conversely, none of the patients with initial Cobb angles of 15° or less or those in SS5, SS6, and SS7 with initial Cobb angles of 30° or less progressed. Predictive progression of 67%, 50%, 43%, 27%, and 60% was observed for subgroups SS1/30°, SS2/20°, SS3/30°, SS4/30°, and SS6/35° respectively.

Conclusion. This larger cohort shows a strong predictive correlation between SS and initial Cobb angle for probability of curve progression in idiopathic scoliosis.

Level of Evidence: 3

We sought to validate the Sanders Skeletal Maturity Staging System to predict curve progression in idiopathic scoliosis. We reviewed and followed 161 patients with initial hand films to skeletal maturity or curve progression to surgery. Risk of progression in this larger cohort was similar to that described by Sanders et al.

*Department of Orthopedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE

Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA; and

Department of Orthopedic Surgery, University of Rochester Medical Center, Rochester, NY.

Address correspondence and reprint requests to Suken A. Shah, MD, Department of Orthopedics, Nemours/Alfred I. duPont Hospital for Children, PO Box 269, Wilmington, DE 19899; E-mail: sshah@nemours.org

Acknowledgment date: September 20, 2013. First revision date: May 27, 2014. Second revision date: November 24, 2014. Acceptance date: November 26, 2014.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, consultancy, grants, patents, royalties, payment for lectures, stocks, travel/accommodations/meeting expenses.

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