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Purpose <p>Triradiate cartilage (TRC) status is commonly used to assess skeletal maturity and progression risk in scoliosis; however, its traditional binary classification as open or closed may inadequately capture critical transitional growth periods. This study aimed to re-evaluate TRC maturation by subdividing it into four stages and to investigate scoliosis progression and growth patterns during the transitional phases.</p> Methods <p>A retrospective longitudinal study was conducted of 179 patients with idiopathic scoliosis (126 girls, 53 boys) who were followed from childhood through early adolescence. Inclusion criteria were age &gt; 6&#xa0;years with an open TRC at baseline, initial major Cobb angle &lt; 45° (mean 27.8° ± 10° in girls and 30.3° ± 9.5° in boys), and documented curve progression to ≥ 50° requiring surgical treatment during adolescence. TRC status was classified as open, closing, initial closed, or fully closed based on radiographic appearance and the Risser sign. Cobb progression rate, spine height increase rate, and standing height increase rate were measured and calculated for the open-, closing-, and initial-closed-TRC stages.</p> Results <p>In both sexes, Cobb progression peaked during the closing-TRC stage, increasing approximately fivefold in girls and more than 30-fold in boys compared with the open-TRC stage (<i>p</i> &lt; 0.0001). Elevated Cobb progression rate persisted into the initial closed-TRC stage. Spine height increase rate did not peak during the closing-TRC and showed a significant inverse correlation with Cobb progression in girls, whereas standing height remained relatively stable and did not correlate with Cobb progression in either sex.</p> Conclusion <p>The closing-TRC stage represents a critical transitional period associated with accelerated scoliosis progression, independent of overall somatic growth. A four-stage TRC framework may improve early risk stratification and clinical decision-making in skeletally immature patients with idiopathic scoliosis.</p>

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The closing triradiate cartilage stage identifies accelerated curve progression in idiopathic scoliosis

  • 期刊论文

  • 发表日期：

    2026年5月4日

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  • Hong Zhang,
  • Judy-Mae Lima,
  • Chanhee Jo,
  • Daniel J. Sucato

摘要

Purpose

Triradiate cartilage (TRC) status is commonly used to assess skeletal maturity and progression risk in scoliosis; however, its traditional binary classification as open or closed may inadequately capture critical transitional growth periods. This study aimed to re-evaluate TRC maturation by subdividing it into four stages and to investigate scoliosis progression and growth patterns during the transitional phases.

Methods

A retrospective longitudinal study was conducted of 179 patients with idiopathic scoliosis (126 girls, 53 boys) who were followed from childhood through early adolescence. Inclusion criteria were age > 6 years with an open TRC at baseline, initial major Cobb angle < 45° (mean 27.8° ± 10° in girls and 30.3° ± 9.5° in boys), and documented curve progression to ≥ 50° requiring surgical treatment during adolescence. TRC status was classified as open, closing, initial closed, or fully closed based on radiographic appearance and the Risser sign. Cobb progression rate, spine height increase rate, and standing height increase rate were measured and calculated for the open-, closing-, and initial-closed-TRC stages.

Results

In both sexes, Cobb progression peaked during the closing-TRC stage, increasing approximately fivefold in girls and more than 30-fold in boys compared with the open-TRC stage (p < 0.0001). Elevated Cobb progression rate persisted into the initial closed-TRC stage. Spine height increase rate did not peak during the closing-TRC and showed a significant inverse correlation with Cobb progression in girls, whereas standing height remained relatively stable and did not correlate with Cobb progression in either sex.

Conclusion

The closing-TRC stage represents a critical transitional period associated with accelerated scoliosis progression, independent of overall somatic growth. A four-stage TRC framework may improve early risk stratification and clinical decision-making in skeletally immature patients with idiopathic scoliosis.