Maturity Indicators in Spinal Deformity

Abstract

Scoliosis from all causes, with the sole exception of adult degenerative deformity, is a disorder of growth. Physicians who treat spinal deformities in children and adolescents should have a basic understanding of growth and its relationship to the progression of scoliosis and be capable of making an accurate determination of maturity. The purpose of this review is to describe the relationship of growth to the progression of scoliosis, to delineate the various methods of determining maturity, and to describe reasonable ways of evaluating maturity in clinical practice. The relationship of growth to scoliosis was well described by the pioneers of scoliosis treatment1-4. However, it was the work of Duval-Beaupere5,6 that clearly demonstrated the close relationship between increased height and scoliosis progression. Her studies showed that curve progression increases markedly at the time of the adolescent growth spurt in both idiopathic and neuromuscular curves and markedly slows or ceases at the time of completion of growth. This is also true for congenital scoliosis7. Because of this tight association between maturity and curve behavior, accurate maturity assessment is crucial for predicting prognosis and determining treatment. Maturation is multidimensional and includes the development of reproductive and secondary sexual characteristics, changes in muscle and fat mass and distribution, and changes in osseous structure. Because curve progression is closely connected with a rapid increase in spinal height at the time of the growth spurt, it is likely that longitudinal growth is the most important dimension of maturity in scoliosis progression. Because serial height information, which is needed to determine where patients are in their growth spurt, is rarely available at the time of patient evaluation, an understanding of the associations among the various maturity markers can be very helpful clinically. The problem with the conventional categorization …