Cheung Samuel Tin Yan, Cheung Garvin Chi Chun, Cheung Jason Pui Yin, Cheung Prudence Wing Hang
Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, People's Republic of China.
JB JS Open Access. 2025 Sep 8;10(3). doi: 10.2106/JBJS.OA.25.00184. eCollection 2025 Jul-Sep.
Cervical vertebral maturation (CVM) is a skeletal maturity method that can be assessed routinely on whole spine radiographs to minimize radiation exposure. Originally used in orthodontics, its role in staging adolescent growth spurt and curve progression in adolescent idiopathic scoliosis (AIS) remains unclear. The aim of this study was to investigate growth rates across CVM stages, its cutoff for indicating peak growth (PG) versus growth cessation (GC), and its relationship with coronal curve progression.
One hundred forty-two AIS patients were prospectively followed from Risser stage 0, until growth completion. Longitudinal data collected included arm span (AS), body height (BH), sitting height (SH), coronal Cobb angle, and maturity assessments. CVM was evaluated through its relationship with growth rates and curve progression rates. A total of 1107 spine radiographs corresponding to longitudinal growth rates were analyzed to detect PG and GC in each patient, with predictive accuracy assessed using receiver operating characteristic curve analysis. Curve progression rate of each CVM stage in treatment-naïve patients was plotted against timing to peak curve progression.
CVM correlated most with Proximal Femur Maturity Index (PFMI) (τ = 0.662, p < 0.001). CVM stage 3 and 6 showed the respective highest and lowest mean growth rates in SH and AS. CVM stage 3 predicted PG with an area under the curve (AUC) of 0.711 to 0.720. CVM stage 5 predicted GC with AUC of 0.840 to 0.850. CVM stage 3 had the highest curve progression rate (0.45° per month). Peak curve progression occurred 5.8 months after CVM 3 and 9.1 months before CVM 4, lagging behind PG by 6.5 months.
CVM stage 3 indicates peak growth, while stage 6 marks growth cessation. In this cohort of AIS patients, GC is more accurately predicted than PG by CVM. Peak curve progression occurred between CVM stage 3 and CVM stage 4.
This study highlights CVM method's ability in indicating timing of growth cessation. CVM can be used to indicate curve progression beyond peak growth, especially until the point of growth cessation.
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
颈椎成熟度（CVM）是一种骨骼成熟度评估方法，可通过全脊柱X线片进行常规评估，以减少辐射暴露。该方法最初用于正畸领域，其在青少年特发性脊柱侧凸（AIS）的青春期生长突增分期和曲线进展中的作用尚不清楚。本研究旨在调查不同CVM阶段的生长速率、其用于指示生长高峰（PG）与生长停止（GC）的临界值，以及它与冠状面曲线进展的关系。
前瞻性随访142例AIS患者，从Risser 0期直至生长结束。收集的纵向数据包括臂展（AS）、身高（BH）、坐高（SH）、冠状面Cobb角和成熟度评估。通过CVM与生长速率和曲线进展速率的关系来评估CVM。分析了总共1107张与纵向生长速率对应的脊柱X线片，以检测每位患者的PG和GC，并使用受试者工作特征曲线分析评估预测准确性。将未经治疗患者每个CVM阶段的曲线进展速率与达到曲线进展高峰的时间作图。
CVM与股骨近端成熟指数（PFMI）的相关性最高（τ = 0.662，p < 0.001）。CVM 3期和6期分别在SH和AS方面显示出最高和最低的平均生长速率。CVM 3期预测PG的曲线下面积（AUC）为0.711至0.720。CVM 5期预测GC的AUC为0.840至0.850。CVM 3期的曲线进展速率最高（每月0.45°）。曲线进展高峰出现在CVM 3期后5.8个月和CVM 4期前9.1个月，比PG滞后6.5个月。
CVM 3期表示生长高峰，而6期标志着生长停止。在该队列的AIS患者中，CVM对GC的预测比PG更准确。曲线进展高峰出现在CVM 3期和CVM 4期之间。
本研究强调了CVM方法在指示生长停止时间方面的能力。CVM可用于指示生长高峰后的曲线进展，尤其是直到生长停止点。
预后II级。有关证据水平的完整描述，请参阅作者须知。
