Continuing with our Risser theme, today we’ll highlight Risser 1. At the Risser 1 stage of growth, a pelvic x-ray will show up to 25% ossification, or “capping” at the top of the iliac crest apophysis from lateral to medial (outside to inside).
Girls typically reach Risser 1 just after menses occurs, however, that’s not a hard and fast rule. We have had several female patients who had not yet experienced menses who presented as Risser 1, 2 and even Risser 3. Weight, hormones, family history and other environmental factors can play a role when it comes to the start of menses, so any of these can be a factor in cases where menses started later than expected.
No matter the Risser stage, our mission is to help patients manage scoliosis to the best possible outcome during the growth process. For our Risser 1 post, we are featuring a girl who came to see us from Washington state. Dr. Marc braced her in the fall of 2015, just prior to her 13th birthday.
When this patient came to our office, her Cobb angles measured 25º thoracic and 12º lumbar. A female patient at Risser 1 presenting with these Cobb angles measurements would normally be recommended for full-time bracing (particularly if there was a family history of scoliosis or significant postural decompensation). For a variety of reasons, Dr. Marc fit this patient in a nighttime brace instead.
Owing in part to her skeletal immaturity and Cobb angle, the in-brace x-ray, taken here in the Boston area, showed overcorrection (middle x-ray above). After the final fitting, the patient returned home and wore her brace faithfully each night. Last August, after a 24-hour out-of-brace x-ray, Dr. Marc had the pleasure of informing her that she had reached skeletal maturity and could discontinue brace wear– always a happy day for a teen with scoliosis! At that time, her x-ray measured 12º thoracic and 4º lumbar – an excellent result!
