Clinical utility of ultrasonography for the assessment of skeletal maturity using the Sanders radiological classification as a reference in patients with juvenile idiopathic scoliosis

Introduction and main objective:

Adolescent idiopathic scoliosis (AIS) is a progressive three-dimensional spinal deformity whose progression is directly related to the stages of growth. The definition of the stage of skeletal maturity becomes a key factor in the prognosis and treatment of the disease. Currently, the Sanders radiographic classification is the most widely used tool to define it. However, technological advances in the field of ultrasound have opened a new window of opportunity. Thus, the main objective of this study was to assess whether ultrasound can be used to determine the state of skeletal maturity based on the Sanders radiological classification.


A case-control study was carried out, in which the case group included patients aged 10 to 16 years diagnosed with AIS; and the control group included those with diagnoses unrelated to scoliosis. For each patient, the Sanders classification was performed radiologically and by ultrasound. Each ultrasound parameter was measured by at least 4 investigators, in order to control for intra and interobserver error. Data were collected on collection sheets specifically designed for the study. Statistical analysis was performed using IBM SPSS Statistics software.


A sample of 70 patients was obtained, with no statistically significant differences between groups. No statistically significant differences were observed between the radiological and ultrasound Sanders classification. Excellent concordance (Kappa coefficient > 0.90) was obtained when assessing interobserver variability in the ultrasound Sanders classification.


Skeletal maturity status can be determined by radiographic or sonographic Sanders classification. Ultrasound measurement has a small learning curve and is easily reproducible if performed consistently.

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