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 potential, which 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
French Risser classification
stage 0: no ossification center at the level of iliac crest apophysis
stage 1: apophysis under 33% of the iliac crest
stage 2: apophysis over 33-66% of the iliac crest
stage 3: apophysis over >66% of the iliac crest
stage 4: complete ossification of the iliac crest
stage 5: complete 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 3:
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
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.
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