Hori Yusuke, Menapace Bryan, Isogai Norihiro, Ciftci Sadettin, Kaymaz Burak, Almeida da Silva Luiz Carlos, Rogers Kenneth J, Yorgova Petya K, Gabos Peter G, Shah Suken A
Nemours Children's Hospital, Delaware, Wilmington, Delaware.
JB JS Open Access. 2025 May 8;10(2). doi: 10.2106/JBJS.OA.24.00189. eCollection 2025 Apr-Jun.
Sanders maturation stages (SMS) 2 to 4 represent periods of rapid growth and are considered ideal candidates for growth modulation surgery, such as anterior vertebral body tethering. A detailed assessment of spine growth during these stages is essential but limited. This study aimed to clarify the differences in growth rates for spine and total body height across SMS 2, 3A, 3B, and 4, as well as to assess cumulative growth until skeletal maturity for these stages.
This single-center, retrospective, case-control longitudinal study evaluated consecutive patients with idiopathic scoliosis staged SMS 2 to 4. T1-S1 spine height, total body height, and curve magnitude were measured at each visit. Monthly growth rates for spine and total body height were calculated between baseline and first follow-up visit (6-12 months). In a subset followed to skeletal maturity, cumulative spine and total body height gain were assessed. To account for height loss due to scoliosis, spine and total body height were adjusted for curve magnitude using validated formulas. Multivariate linear regression models were employed to evaluate the relationship between SMS and growth, adjusting for confounding factors.
A total of 517 patients (68% female) were included. Spine height growth was highest in patients at SMS 3A, approximately 1.4 times stage 2, 1.5 times stage 3B, and 1.8 times stage 4. Total body height growth rates were comparable between SMS 2 and 3A, both significantly exceeding SMS 3B and 4. Among 314 patients followed to skeletal maturity, cumulative growth in spine and total body height was greatest in patients at SMS 2.
This study demonstrated that spinal growth was most pronounced in patients at SMS 3A, while total body height growth was greatest during SMS 2 and 3A. Less mature patients exhibited greater cumulative growth potential in both spine and total body height. These findings provide crucial insights for determining the optimal timing of growth modulation surgery.
Level III Case-control study. See Instructions for Authors for a complete description of levels of evidence.
桑德斯成熟阶段（SMS）2至4代表快速生长时期，被认为是生长调节手术（如椎体前路拴系术）的理想对象。对这些阶段脊柱生长进行详细评估至关重要，但目前有限。本研究旨在阐明SMS 2、3A、3B和4阶段脊柱和全身高度的生长速率差异，并评估这些阶段直至骨骼成熟的累积生长情况。
本单中心、回顾性、病例对照纵向研究评估了连续的特发性脊柱侧凸患者，其处于SMS 2至4阶段。每次随访时测量T1-S1脊柱高度、全身高度和侧弯度数。计算基线与首次随访（6至12个月）之间脊柱和全身高度的月生长速率。在随访至骨骼成熟的亚组中，评估脊柱和全身高度的累积增长情况。为了考虑脊柱侧凸导致的身高损失，使用经过验证的公式对脊柱和全身高度进行侧弯度数校正。采用多变量线性回归模型评估SMS与生长之间的关系，并对混杂因素进行校正。
共纳入517例患者（68%为女性）。SMS 3A阶段患者的脊柱高度生长最高，约为2阶段的1.4倍、3B阶段的1.5倍和4阶段的1.8倍。SMS 2和3A阶段的全身高度生长速率相当，均显著超过SMS 3B和4阶段。在随访至骨骼成熟的314例患者中，SMS 2阶段患者的脊柱和全身高度累积生长最大。
本研究表明，SMS 3A阶段患者的脊柱生长最为显著，而SMS 2和3A阶段的全身高度生长最大。不太成熟的患者在脊柱和全身高度方面均表现出更大的累积生长潜力。这些发现为确定生长调节手术的最佳时机提供了关键见解。
III级病例对照研究。有关证据水平的完整描述，请参阅作者须知。
