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Updated: Jun 28, 2026
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Evaluation of Patients' Posture and Gait Profile After Lumbar Fusion Surgery by Video Rasterstereography and Treadmill Gait Analysis
Published on: March 23, 2019
Improved accuracy in Risser sign grading with lateral spinal radiography
1Department of Pediatric Orthopedics and Traumatology, Klinika Ortopedii Dzieciecej, University of Medical Sciences, Ul. 28 Czerwca 1956 roku nr 135, 61-545, Poznan, Poland. kotwicki@ump.edu.pl
Summary
The Risser sign, used for spinal growth assessment, is often inaccurate. Analyzing lateral spinal radiographs with Lateral Risser Modifiers improves accuracy by visualizing the full iliac apophysis ossification.
Area of Science:
- Orthopedics
- Radiology
- Pediatric Spine Surgery
Background:
- The Risser sign is crucial for assessing remaining spinal growth in adolescents.
- Current Risser sign grading methods have limitations, particularly in grades 3 and 4, due to obscured iliac apophysis ossification on frontal radiographs.
Purpose of the Study:
- To evaluate the full ossification course of the iliac apophysis.
- To determine the relevance of lateral spinal radiographs for more accurate Risser sign grading.
Main Methods:
- Cross-sectional analysis of frontal and lateral spinal radiographs from 201 girls (10.2–20.0 years).
- Quantification of posterior iliac apophysis ossification on lateral views using a four-grade system (A-D).
- Comparison of Risser grading between frontal and lateral views, with introduction of Lateral Risser Modifiers.
Main Results:
- The posterior one-third of the iliac apophysis, obscured on frontal views, is visible on lateral radiographs.
- Lateral radiographs revealed different grading in 29% of patients compared to frontal views.
- Lateral Risser Modifiers allowed more precise diagnosis of capping and fusion, identifying simultaneous ossification in 25% of patients at lower Risser grades.
Conclusions:
- Standard Risser sign grading overlooks a significant portion of the iliac apophysis, impacting accuracy.
- Incorporating lateral spinal radiographs and Lateral Risser Modifiers enhances the precision of Risser sign assessment for spinal growth evaluation.
