Risser Sign

Aka: Risser Sign, Risser's Sign, Risser Grade, Risser Grading, Iliac Apophysis Ossification

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II. Indications

  1. Skeletal Maturity estimation in Scoliosis evaluation
  2. Scoliosis progression risk related to skeletal maturity

III. Physiology

  1. Iliac apophysis calcification begins at Puberty
    1. Calcification completed over 2 year period
    2. Completed with apophysis fusion to iliac crest
  2. Calcification (or ossification) begins anterolaterally
    1. Anterior superior iliac spine is first to calcify
    2. Calcification progresses posteromedially

IV. Grading (based on iliac crest divided into 4 quadrants)

  1. Risser 1: 25% Iliac Apophysis Ossification
    1. Anterior Superior iliac spine (anterolateral)
    2. Seen in prepuberty or early Puberty
  2. Risser 2: 50% Iliac Apophysis Ossification
    1. Ossification extends halfway across iliac wing
    2. Seen immediately before or during growth spurt
  3. Risser 3: 75% Iliac Apophysis Ossification
  4. Risser 4: 100% Iliac Apophysis Ossification
    1. Adjacent to sacroiliac joint (posteromedial)
    2. Indicates slowing of growth
  5. Risser 5: Iliac apophysis fuses to iliac crest
    1. Indicates cessation of growth

V. References

  1. Lonstein (July 1989) J Musculoskeletal Med, p. 37-54
  2. Greiner (2002) Am Fam Physician 65(9):1817-22 [PubMed]
  3. Haasbeek (1997) Postgrad Med 101(6):207-16 [PubMed]

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