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Purpose <p>To investigate the magnitude and incidence of curve progression and identify clinical factors independently associated with late-stage progression in untreated female adolescent idiopathic scoliosis (AIS) patients with Risser grade ≥ 3.</p> Methods <p>This retrospective cohort study included 915 female AIS patients with Risser grade ≥ 3 and a major Cobb angle ≥ 10° without prior treatment. The primary outcome was change in the major Cobb angle (ΔCobb). Patients were additionally divided into the progressive (ΔCobb ≥ 6°) and the non-progressive groups.</p> <p>Multivariable regression analyses were performed to evaluate independent factors associated with curve progression. Covariates included age, months since menarche, body mass index (BMI), residual height growth, and main curve location.</p> Results <p>Overall, 111 patients (12.1%) experienced clinically significant progression. Multivariable linear regression analysis revealed that lower BMI, lower Risser grade, greater residual height growth, and smaller baseline Cobb angle were independently associated with a greater magnitude of curve progression.　Curve location was a significant predictor, with thoracolumbar curve showing significantly less progression magnitude compared to proximal thoracic curve.</p> <p>Multivariable logistic regression identified lower BMI, lower Risser grade, and greater residual height growth as independent factors associated with clinically significant progression.</p> Conclusion <p>Despite late-stage skeletal maturity, a clinically significant risk of curve progression persists in female AIS patients with a Risser grade ≥ 3. The Risser sign is insufficient; lower BMI, residual height growth, and specific curve patterns are independent factors of late-stage progression. They should be integrated with skeletal maturity indicators to improve risk stratification and guide management decisions for traditionally low-risk patients.</p>

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Curve progression in female adolescent idiopathic scoliosis with Risser grade ≥ 3: incidence, magnitude, and risk factors in a cohort of 915 unbraced female patients

  • 期刊论文

  • 发表日期：

    2026年5月4日

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  • Yusuke Setojima,
  • Toshiaki Kotani,
  • Tomoyuki Asada,
  • Shun Okuwaki,
  • Yosuke Ogata,
  • Shuhei Ohyama,
  • Yasushi Iijima,
  • Tsuyoshi Sakuma,
  • Shohei Minami,
  • Seiji Ohtori

摘要

Purpose

To investigate the magnitude and incidence of curve progression and identify clinical factors independently associated with late-stage progression in untreated female adolescent idiopathic scoliosis (AIS) patients with Risser grade ≥ 3.

Methods

This retrospective cohort study included 915 female AIS patients with Risser grade ≥ 3 and a major Cobb angle ≥ 10° without prior treatment. The primary outcome was change in the major Cobb angle (ΔCobb). Patients were additionally divided into the progressive (ΔCobb ≥ 6°) and the non-progressive groups.

Multivariable regression analyses were performed to evaluate independent factors associated with curve progression. Covariates included age, months since menarche, body mass index (BMI), residual height growth, and main curve location.

Results

Overall, 111 patients (12.1%) experienced clinically significant progression. Multivariable linear regression analysis revealed that lower BMI, lower Risser grade, greater residual height growth, and smaller baseline Cobb angle were independently associated with a greater magnitude of curve progression.　Curve location was a significant predictor, with thoracolumbar curve showing significantly less progression magnitude compared to proximal thoracic curve.

Multivariable logistic regression identified lower BMI, lower Risser grade, and greater residual height growth as independent factors associated with clinically significant progression.

Conclusion

Despite late-stage skeletal maturity, a clinically significant risk of curve progression persists in female AIS patients with a Risser grade ≥ 3. The Risser sign is insufficient; lower BMI, residual height growth, and specific curve patterns are independent factors of late-stage progression. They should be integrated with skeletal maturity indicators to improve risk stratification and guide management decisions for traditionally low-risk patients.