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Overlapping Sanders scores challenge age-based AIS/JIS classifications.

Matthew Weintraub1, Omar Taha1, Mehdi M Elfilali2

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Summary

Chronological age is unreliable for classifying idiopathic scoliosis subtypes. The Sanders Maturity Scale (SMS) offers a better measure of skeletal maturity for predicting scoliosis progression and guiding treatment.

Keywords:
Adolescent idiopathic scoliosis (AIS)Idiopathic scoliosisJuvenile idiopathic scoliosis (JIS)Maturity markersSkeletal maturity markers

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Area of Science:

  • Orthopedics
  • Pediatric Spine Surgery
  • Skeletal Maturity Assessment

Background:

  • Idiopathic scoliosis classification traditionally uses age, differentiating juvenile (JIS) from adolescent (AIS).
  • Age-based cutoffs may not accurately reflect physiological maturity, impacting curve progression prediction and treatment decisions.

Purpose of the Study:

  • To investigate skeletal maturity differences around the JIS-AIS age threshold using the Sanders Maturity Scale (SMS).
  • To evaluate if SMS provides a more accurate assessment of maturity than chronological age.

Main Methods:

  • Retrospective review of a multicenter pediatric spine registry.
  • Inclusion of 637 patients (7-13 years) with idiopathic scoliosis and documented SMS scores.
  • Analysis of SMS distributions across age bands (9-10 vs. 10-11 years) and demographic factors.

Main Results:

  • Significant overlap (50%) in SMS scores between 9-10 and 10-11-year-olds.
  • Many AIS patients showed skeletal immaturity comparable to JIS patients.
  • Factors like height, weight, BMI, sex, and ethnicity correlated with skeletal maturity variations.

Conclusions:

  • Chronological age is an unreliable indicator of skeletal maturity and growth risk in idiopathic scoliosis.
  • The Sanders Maturity Scale (SMS) provides a more precise, physiology-based classification.
  • Adopting SMS-based classification can improve treatment individualization, clinical trial stratification, and patient outcomes.