Low reliability of the Risser sign in consecutive radiographs: a case series
© Negrini et al.; licensee BioMed Central Ltd. 2013
Published: 18 September 2013
The low reliability of the Risser sign has been described in previous studies; however, the test/retest reliability of the Risser sign in different radiographs has not been examined or reported.
The goal of this report was to present data collected from studying a group of adolescent idiopathic scoliosis (AIS) patients whose Risser sign decreased in two consecutive X rays.
Case series using the European Risser test.
4 to 2
1 to 0
2 to 1
4 to 3
Months between x-rays
In brace x-ray
Change of x-ray machine
Change of rotation of the pelvis
C7+L3 distance (cm)
Conclusions and discussion
At this stage, the following explanatory hypotheses can be drawn:
Technical radiological differences (exposure, machine)
Variation of pelvis positioning
Postural changes influencing the pelvis
Brace compression on the pelvis
According to our study results, all of the hypotheses include data both in favor and against the reliability of the Risser sign. Since the Risser sign is a 2D evaluation of a 3D phenomenon, pelvis repositioning could perhaps be the most plausible explanation.
This case series is open to the possibility that the Risser sign is even less reliable than originally considered. Unfortunately, this result cannot be checked experimentally due to ethical reasons. Nevertheless, observational designs could be considered in the future.
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