Sooo einfach ist es ja nun auch nicht. Hier geht es ja um das Ergebnis nach zwei Jahren Korsett-Therapie (nicht um das erste Kontrollröntgen nach 6-8 Wochen, wie Du schreibst). Lodri hat ihr Korsett also mit 13 gekriegt. Ich bezweifle, dass sie da schon so verknöchert war, dass nicht mehr rauszuholen war. V.a. erklärt das nicht, warum nicht öfter aufpelottiert wurde. Soll das heißen, in Dresden (oder wo auch immer) wird aufs Röntgenbild geguckt und man sagt sich "Oh, Risser 4 (oder gar 5), da können wir uns das Aufpelottieren sparen!"??
Dass das Risserzeichen nicht grade die beste Methode ist, um noch zu erwartendes WS-Wachstum abzuschätzen, sollte sich auch rumgesprochen haben. Ansonsten empfehle ich wieder mal nen Blick in die Literatur:
z.B.
Spine. 1999 Mar 15;24(6):535-8.
Spinal growth and a histologic evaluation of the Risser grade in idiopathic scoliosis.
Abstract:
STUDY DESIGN: Thirty-four patients with idiopathic scoliosis who underwent anterior spinal surgery as part of the correction of spinal deformity were studied prospectively. Superior and inferior endplates were harvested and examined histologically for evidence of residual growth activity. This was then correlated with Risser grades, chronologic age, and pubertal status. OBJECTIVES: To clarify the correlation between Risser grade and vertebral endplate growth potential in patients with idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: The importance of longitudinal spinal growth in patients with idiopathic scoliosis and its correlation with curve progression and the crankshaft phenomenon after posterior fusion are well recognized. The Risser grade, which shows the extent of excursion of the iliac apophysis on serial plain radiographs, is commonly used to estimate residual spinal growth. However, the correlation between the Risser grade and vertebral endplate growth potential in patients with idiopathic scoliosis remains unclear. METHODS: Superior and inferior endplates were harvested from these patients and examined histologically for evidence of residual growth. This was correlated with Risser grade, chronologic age, and pubertal status. RESULTS: Risser Grade 5 was found to be the only indicator of cessation of vertebral growth in idiopathic scoliosis.
Of the 14 patients with Risser Grade 4, 10 showed significant growth activity in the vertebral endplates. The reliability of Risser Grade 4 increases when combined with chronologic age and time since menarche in female patients. CONCLUSIONS: The crankshaft phenomenon is reported to occur only in patients with Risser Grade 2 or less, particularly those with open triradiate cartilages. Our findings of significant endplate growth activity, even in patients with Risser Grade 4, make it unlikely that the crankshaft phenomenon is caused purely by longitudinal spinal growth.
oder
Spine. 2004 Jan 1;29(1):47-50.
The rib epiphysis and other growth centers as indicators of the end of spinal growth.
STUDY DESIGN: The association of capping and fusion of the iliac apophysis, and closure of the proximal humerus and rib epiphyseal growth plates to the end of spinal growth, was evaluated in a cohort of patients with juvenile and adolescent idiopathic scoliosis. OBJECTIVES: To determine the association of closure of the proximal rib epiphysis growth plate, the proximal humeral epiphyseal growth plate, and capping (Risser 4), and fusion (Risser 5) of the iliac apophysis to growth cessation in patients with idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Accurate evaluation of remaining spinal growth is the basis of decision-making in skeletally immature patients with scoliosis. The ossification of the iliac apophysis (Risser sign) has been the main indicator used for making this determination. The accuracy of this sign has been called into question and may be supplemented with data from other growth centers. METHODS: A total of 101 patients with juvenile or adolescent idiopathic scoliosis undergoing brace treatment were followed for a minimum of 2 years following termination of bracing. Serial height measurements and evaluation of iliac apophysis ossification, proximal humerus, and rib epiphysis growth center closure were performed for each patient. RESULTS: The iliac apophysis capped (Risser 4) at a mean age of 14.9 years for girls and 16.0 years in boys.
Seventy-six of the 101 patients (75.2%) had further growth after Risser 4 status. The mean growth was 1.75 cm in the girls and 2.46 cm in the boys. No growth occurred after iliac apophysis fusion (Risser 5) or closure of either the rib epiphysis or proximal humerus growth plates. CONCLUSIONS: Capping of the iliac apophysis is not the final indicator for the end of spinal growth. Other growth centers should be evaluated in conjunction with serial height measurements when making decisions on the management of the scoliosis patient.
Ich nehme mal an, dass die Flexibilität auch nicht so eng an dieses Reifezeichen gekoppelt ist, sonst hätten einige Erwachsene aus dem Forum in ihren Adultkorsetts nicht so schöne Primärkorrekturen (
viewtopic.php?t=4723).
Lodri hat wohl keine sonderlich progrediente Skoli und insofern schon Glück gehabt, dass trotz des nur einmaligen Aufpelottieren und den zu geringen Tragzeiten nix passiert ist, wenn man das mal mit anderen Geschichten aus dem Forum vergleicht. Aber falls Du wirklich irgendwo Skoliosen behandelst, hoffe ich nicht, dass Du Dich nur auf Risser verlässt und dann ne lausige Korrektur schon als gute Leistung bezeichnest ("schließlich ist der Patient ja schon verknöchert"). Falls Du Ärzte kennst, die zu 15- oder 16jährigen sagen, dass sie austherapiert sind, dann sollen die bitte wenigstens einfach mal nach dem Zeitpunkt der ersten Regel fragen. Ich wünschte, dass hätte man mich mal gefragt.
Gruß zurück,
Charp
Du bist erst 15, wie ich woanders gelesen habe. Als Teenie müsstest du bei den Gradzahlen die Chance haben, auf 0° zu kommen. Dein Arzt scheint mir eher nicht kompetent zu sein.
