Elbow (Olecranon) Posted in: Understanding Scoliosis

The following post was submitted by Dr. Andrew Strauss of The Hudson Valley Scoliosis Correction Center. Dr. Strauss has been CLEAR-certified since 2008 and offers both Standard Treatment and Intensive Care at his practice in New York.

Can your doctor see the future of your scoliosis?

A new study in the Journal of Pediatric Orthopaedics says that doctors can reliably determine the risk of progression for adolescents with idiopathic scoliosis during the peak of their growth.

Using data from 372 patients, researchers looked at the relationship between curve size and stages of skeletal maturity to see if there are predictable changes over time. Skeletal maturity (when your bones are fully developed) has typically been determined by something called the Risser Sign, which focuses on pelvic bone development. In this recent study, a new technique was used that evaluates the bone development at the elbow.

What is the Risser Sign?

risser sign
The 5 grades of the Risser scale. Source: Department of Orthopaedic Surgery at University Stellenbosch, South Africa.

In 1958, Joseph C. Risser noticed that the state of formation of the bone at the top of the pelvis was also linked to a patient’s spinal skeletal maturity. It can be difficult to determine bone age by assessing the spinal bones, so this observation offered a new way for doctors to gather information about the spine by looking at another part of the body.

Risser found that when the outer top edge of the pelvis had fully developed it generally coincided with the development of the vertebral growth plates (or spinal bones). He concluded that “the attachment of the iliac apophysis has proved to be an excellent physiologic sign to indicate the completion of the vertebral growth,” an observation that we now refer to as the Risser sign.

Doctors use the Risser sign to indirectly measure skeletal maturity by determining the stage of ossification of the iliac apophysis and using this information to gauge the approximate ossification of the spinal bones. It uses a scale of 0 to 5 to measure the progression of bone formation, with 5 meaning that skeletal maturity has been reached.

How the Elbow Helps Determine Bone Age

Previous studies looking at scoliosis and skeletal age suggest that the main progression of idiopathic scoliosis occurs during peak height growth velocity. This is the time when adolescents experience the maximum rate of growth, and it corresponds with the rapid phase of pubertal growth. This typically occurs between the ages of 11 and 13 for girls and 13 and 15 years in boys.

Location of the olecranon, or the bony tip of the elbow. Source: American Academy of Orthopaedic Surgeons

During this time, the Risser sign remains at grade 0, meaning no skeletal maturity. Things are moving fast! To assess skeletal maturity prior to Risser grade 1, the researchers in this new study used a method in which changes in the development of the olecranon (the bony prominence of the elbow) are assessed instead. Looking at this bony bump allows skeletal age to be evaluated easily and accurately at intervals of six months during Risser grade 0.

Predicting Scoliosis Progression

Using elbow rather than pelvis bones, this new study was able to make a connection between skeletal maturity and scoliosis curves in adolescents. And as a result, the researchers found that it’s possible to reliably predict the risk of curve progression in idiopathic scoliosis at the start of puberty:

  • Curves greater than 30° have a 100% risk of progressing over 45°.
  • Curves around 21-30° have a progression risk of 72.5%.

The research also shows that a curve progression rate of 6-10 degrees per year represents a 71.8% risk that a patient could one day be considered a candidate for surgical treatment. A rate greater than 10 degrees per year represents a risk of 100%. However, many conservative scoliosis professionals now consider surgery an “elective” procedure and only medically necessary for the largest curves (above 70 degrees), where there is definite evidence of lung compromise.

Are you the parent or doctor of a child or teenager with idiopathic scoliosis? What questions do you have about the progression of their curve over time? I look forward to hearing from you in the comments.


About the Author: Dr. Andrew Strauss is the founder and head practitioner of The Hudson Valley Scoliosis Correction Center in Nanuet, NY. He earned a B.S. in Biology from the University of New Hampshire as well as a D.C. from the Palmer College of Chiropractic. For the past 30 years, Dr. Strauss has been successfully treating scoliosis patients using a combination of traditional chiropractic methods and CLEAR protocols. The CLEAR Scoliosis Institute has awarded Dr. Strauss our highest level of certification.

6 comments on “What is the Risk of Your Scoliosis Progressing?”

  1. 1
    J. Miller on April 19, 2017

    I wish this was around in the 1940’s when I was young….

    I developed scoliosis at age 11 with a 70 degree curve and had my first spinal fusion
    at age 12….I was in a full body cast for 8 months and body braces for 5 years.
    I never had the other two fusions done!

    Needless to say my curve is now 145 degrees . I don’t have to tell you what severe pain
    I deal with 24/7 and only have one lung that functions, and at only 60%. The other lung
    stopped functioning over 40 years ago.

    I have had two heart attacks and surgery and now have severe A-Fib.. .

    I wish I could turn the clock back and be a patient at the CLEAR Scoliosis Center!
    Keep up the good work!

  2. 2
    Andrew J Strauss on June 29, 2017

    Thank you for your comments. It is very important to hear both the positive and the negative experiences of spine surgery. Yes, now there are more modern techniques, both non surgical like that offered by CLEAR Institute trained clinicians as well as non fusion surgical techniques for those few cases that do not respond to the CLEAR scoliosis specific exercise program.

  3. 3
    Cheryl Moosa on September 10, 2017

    Dear Dr. Strauss my 13 year old has 40 degree curve that I noticed about seven months ago I have been to a physio therapist who does exercise weekly she referred me to Orthopedist who suggested a full body brace that would cost us around 5000 dollars for two years however I visited a orthopedic surgeon and he suggested we wait for six months and watch for progression if this is the case surgery would be required kindly advise where I can get help in my country I researched your therapy intensely unfortunately I cannot find a Dr. in our country who can assist kindly advise if I can arrange to bring my daughter to your country in order to get help desperately before her scoliosis progress as I am already told that surgery in inevitable

  4. 4
    Andrew Strauss on September 12, 2017

    Dear Cheryl,
    I understand the difficulty of your situation. It can be frustrating to have your medical expert tell you to take no action until surgery is required. CLEAR Institute trained doctors take a proactive approach of scoliosis specific exercises combined with bracing when a brace is necessary. Our Intensive level trained doctors will accept patients from out of their area for short (1-2 week) scoliosis specific exercise development and training programs. This may be appropriate for your daughter. You can find a list of these doctors on this website. Look at the top of the page for “Find a Doctor”. With all best regards for your daughters successful outcome. Dr Strauss

  5. 5
    Jennifer Davis on September 21, 2017

    My 14 year old daughter has a spinal curve of 44 degrees and a risser of 0. She currently wears the Boston brace. I am not convinced this will prevent progression of her curve. Her doctor is waiting to recheck her in 6 months. His only other plan of action is to do a spinal fusion. I am not sold on either!! She is very athletic and does not want a spinal fusion. Is VBT an option for her? Would a scoliosis boot camp help at this stage? What are my other options?

    1. 6
      Dr. Josh Woggon on September 22, 2017

      A 44 degree curve with a Risser of 0 is considered very high risk. There is an almost 100% chance that this type of curve will progress and continue to get worse without treatment. VBT (Vertebral Body Tethering) is a new fusionless type of scoliosis surgery which holds a great deal of promise. You can reach out to Dr. Amer Samdani or Dr. Randy Betz to learn more about whether or not your daughter would be a good candidate for this operation.
      CLEAR Intensive Care (IC) Treatment would be another option worth exploring. You can read more about people’s experiences on our website, including Patient Success Stories (https://www.clear-institute.org/about/patient-success-stories/), testimonials (https://www.clear-institute.org/about/testimonials/), and research articles (https://www.clear-institute.org/about/research/, see Long-Term Chiropractic Management of Progressive Adolescent Idiopathic Scoliosis: A Case Study, down at the bottom).
      You can find a list of CLEAR doctors here: https://www.clear-institute.org/find-a-doctor/

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