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Purpose <p>The current classification of idiopathic scoliosis relies on chronological age cutoffs to differentiate juvenile (JIS) from adolescent (AIS) subtypes. However, age-based distinctions may not reliably reflect physiological maturity, a critical factor for predicting curve progression and guiding treatment. This study investigates skeletal maturity differences across the traditional JIS-AIS age threshold using the Sanders maturity scale (SMS).</p> Methods <p>A retrospective review was conducted using a multicenter pediatric spine registry. Patients aged 7–13&#xa0;years with idiopathic scoliosis and documented SMS scores were included. SMS distributions were analyzed across age bands surrounding the JIS-AIS cutoff (9–10 vs. 10–11&#xa0;years). Demographic and anthropometric data evaluated factors associated with skeletal maturity variation.</p> Results <p>Among 637 patients (86% female and 14% male), there was a 50% overlap in SMS scores between 9–10 and 10–11-year-olds, with many AIS-classified patients exhibiting skeletal immaturity similar to JIS counterparts. SMS stages 3–5 were associated with greater height, weight, and BMI than stages 1–2 within the same age range. Female and non-Caucasian patients were more likely to show advanced skeletal maturity. These findings underscore significant heterogeneity in growth potential near the age-based diagnostic boundary.</p> Conclusion <p>Chronological age alone does not reliably reflect skeletal maturity or growth risk in idiopathic scoliosis patients. The Sanders Maturity Scale offers a more precise, physiology-based alternative to age-based classification and should be considered in diagnostic, prognostic, and treatment frameworks. Transitioning toward skeletal maturity-based classification could enhance treatment individualization, improve clinical trial stratification, and optimize patient outcomes.</p>

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Overlapping Sanders scores challenge age-based AIS/JIS classifications

  • 期刊论文

  • 发表日期：

    2026年4月16日

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  • Matthew Weintraub,
  • Omar Taha,
  • Mehdi M. Elfilali,
  • Joseph G. Barile,
  • Jessica L. McQuerry,
  • Tenner Guillaume,
  • Michael G. Vitale,
  • Benjamin D. Roye

摘要

Purpose

The current classification of idiopathic scoliosis relies on chronological age cutoffs to differentiate juvenile (JIS) from adolescent (AIS) subtypes. However, age-based distinctions may not reliably reflect physiological maturity, a critical factor for predicting curve progression and guiding treatment. This study investigates skeletal maturity differences across the traditional JIS-AIS age threshold using the Sanders maturity scale (SMS).

Methods

A retrospective review was conducted using a multicenter pediatric spine registry. Patients aged 7–13 years with idiopathic scoliosis and documented SMS scores were included. SMS distributions were analyzed across age bands surrounding the JIS-AIS cutoff (9–10 vs. 10–11 years). Demographic and anthropometric data evaluated factors associated with skeletal maturity variation.

Results

Among 637 patients (86% female and 14% male), there was a 50% overlap in SMS scores between 9–10 and 10–11-year-olds, with many AIS-classified patients exhibiting skeletal immaturity similar to JIS counterparts. SMS stages 3–5 were associated with greater height, weight, and BMI than stages 1–2 within the same age range. Female and non-Caucasian patients were more likely to show advanced skeletal maturity. These findings underscore significant heterogeneity in growth potential near the age-based diagnostic boundary.

Conclusion

Chronological age alone does not reliably reflect skeletal maturity or growth risk in idiopathic scoliosis patients. The Sanders Maturity Scale offers a more precise, physiology-based alternative to age-based classification and should be considered in diagnostic, prognostic, and treatment frameworks. Transitioning toward skeletal maturity-based classification could enhance treatment individualization, improve clinical trial stratification, and optimize patient outcomes.