Citation, DOI, disclosures and article data
Citation:
Luijkx T, Knipe H, Glick Y, et al. Risser staging system. Reference article, Radiopaedia.org (Accessed on 09 Jun 2023) https://doi.org/10.53347/rID-31917
Disclosures:
At the time the article was last revised Henry Knipe had the following disclosures:
- Integral Diagnostics, Shareholder (ongoing)
- Micro-X Ltd, Shareholder (ongoing)
These were assessed during peer review and were determined to
not be relevant to the changes that were made.
View Henry Knipe's current disclosures
The Risser staging system is used to grade skeletal maturity based on the level of ossification and fusion of the iliac crest apophyses. It is used primarily in planning corrective surgery for scoliosis as a marker for skeletal maturity, which is a surrogate for growth velocity and growth potential, which in turn are important predictors of curve progression 3.
Classification
United States Risser staging system
stage 0: no ossification center at the level of iliac crest apophysis
stage 1: apophysis under 25% of the iliac crest
stage 2: apophysis over 25-50% of the iliac crest
stage 3: apophysis over 50-75% of the iliac crest
stage 4: apophysis over >75% of the iliac crest
stage 5: complete ossification and fusion of the iliac crest apophysis
As stage 0 and stage 5 can appear similar, age and long bone growth plates may be of help in discriminating between the two ref:
stage 0 patients will still have open growth plates in most of the long bones and will likely be younger than 16 years (female) or 18 years (male)
stage 5 patients will have no open growth plates in the long bones
French Risser classification
The French Risser staging system has stage 4 representing complete ossification and fusion and divides partial fusion into three thirds, with stages 1, 2, and 3 representing 0-33%, 33-66% and >66% of fusion, respectively ref.
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History and etymology
The Risser sign (iliac aphosyseal fusion indicates vertebral growth completion) was first described in 1958 by Joseph C. Risser (1892–1982), an American orthopedic surgeon 3-5.
- 1. Hacquebord JH, Leopold SS. In brief: The Risser classification: a classic tool for the clinician treating adolescent idiopathic scoliosis. Clin. Orthop. Relat. Res. 2012;470 (8): 2335-8. doi:10.1007/s11999-012-2371-y - Free text at pubmed - Pubmed citation
- 2, Malfair D, Flemming AK, Dvorak MF, Munk PL, Vertinsky AT, Heran MK, Graeb DA. Radiographic evaluation of scoliosis: review. (2010) AJR. American journal of roentgenology. 194 (3 Suppl): S8-22. doi:10.2214/AJR.07.7145 - Pubmed
- 3. Hacquebord J & Leopold S. In Brief: The Risser Classification: A Classic Tool for the Clinician Treating Adolescent Idiopathic Scoliosis. Clin Orthop Relat Res. 2012;470(8):2335-8. doi:10.1007/s11999-012-2371-y - Pubmed
- 4. Risser J. The Classic: The Iliac Apophysis: An Invaluable Sign in the Management of Scoliosis. Clinical Orthopaedics & Related Research. 2010;468(3):646-53. doi:10.1007/s11999-009-1096-z
- 5. Manring M & Calhoun J. Joseph C. Risser Sr., 1892-1982. Clinical Orthopaedics & Related Research. 2010;468(3):643-5. doi:10.1007/s11999-009-1095-0
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