Skeletal and Vertebral Age - A Literature Review

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Skeletal and vertebral age

–

a literature review

Sergio Polizio TerçarolliJaw Functional Orthopedics Specialist

ABSTRACT

The determination of the best moment to intervene is a constant pursuit inorthodontic treatments. The evaluation of the skeletal age can provide additionalinformation that can contribute for this decision. Hand-wrist radiography isrecognized as a reliable parameter to evaluate the skeletal age of a patient. In1972, Lamparski proposed the use of lateral cephalometric radiography and the

observation of cervical vertebrae as a new parameter to evaluate the patient’s

skeletal age. Several studies were and are being carried out to confirm theefficiency of this evaluation. A review of the literature, and whether the reliabilityof this type of interpretation is safe, are the objectives of this work.

Key words

: jaw functional orthopedics, cervical vertebrae, vertebral age,cephalometry, maturity.=======================================================Understanding the development pattern of growing patients is one of thegreatest responsibilities of Jaw Functional Orthopedists and/or Orthodontists.It is of fundamental importance for the functional orthopedic or orthodontictreatment to know if the growth surge will happen, is happening or hashappened

1

.

Based on this information, it is possible to intervene at the mostappropriate moment, obtaining faster and more efficient results.Manifestations of secondary sexual characteristics

2,3

, height and weightvariations

4

, chronological age

5

, dental age

6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24

2

and skeletal age

7,25,26,27,28,29,30,31,32,33

are part of the enormous arsenal referencedin literature, and serve as criteria for the evaluation of the physiological age ofan individual. These criteria are based on the degree of maturity of differenttissues of the system and can be applied together or separately

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.Several body locations were studied to determine skeletal maturity or skeletalage.: ulnar sesamoid of the thumb

34,35,36

, wrist and hand

27,28,31

,teeth

9,10,11,12,14,15,16,17,18,20,21,22,23

, calcification of the hook of the hamate bone

37

,development of the epiphysis of the middle phalanx of the 3

rd

finger

28,36,37

.

Based on Lamparski’s works

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, another source of inquiry and reference in thestudy of skeletal maturity of individuals can be evaluated: the vertebral skeletalage.

“The process of skeletal maturation consists of differentiation, growth and

change of shape. These alterations start at the ossification centers and end withthe complete development of the bone. The entire process can be accompanied

or investigated by radiographic exams”

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.

As the concern with the quality of life of patients is ever more present, one of thealternatives to reduce the amount of ionizing radiation

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(elimination of hand-wrist radiograph), is the use of lateral cephalometric radiography, which ispresent in any routine orthodontic exam, to evaluate the skeletal maturity of anindividual.Thus, structures not observed before, such as the frontal sinus

41

and cervicalvertebrae

1,25,38,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57

became the objective ofinvestigations. Other alternatives, such as the inclusion of the first three fingersof the right hand in a cephalometric radiograph

58,59

and the periapical x-ray ofthe middle finger to evaluate the middle phalanx, were also investigated

58

.

A review of the literature about the reliability of evaluating the maturation ofcervical vertebrae (vertebral skeletal age) is the subject of this article.

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LITERATURE REVIEWThe vertebral column is formed by cervical, thoracic and lumbar vertebrae andby the sacrum

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. The first seven vertebrae form the cervical column, with greatsimilarity between the four last ones

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. Maturational alterations can be seen frombirth till maturity

60,62

. Lamparski

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proposed in his study to examine growth (increase in size with age)and development (maturation) of cervical vertebrae to determine if alterationsfound in this area could be used to evaluate skeletal age in lieu of hand-wristradiographs. His method was based on the works by Bick and Copel

62

, Toddand Pyle

63

, Eslberg and Duke

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, Lanier

65

e Hinck, Hopkins, Savara

66

.

Lamparski

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then established a maturational pattern for cervical vertebrae usingvertebrae C2, C3, C4, C5 and C6. This standardization consisted of 6 stages.The following conclusions were taken from his work: the maturational changesthat occur between the second and sixth cervical vertebrae can be used toevaluate the skeletal age of an individual; the evaluation of vertebral age isstatistically valid and reliable, and has the same clinical value of hand-wristevaluations, thus, an additional radiograph is not needed to evaluate growth

potential; the cervical vertebrae maturation indicators (CVMI’s) are: ini

tiation anddevelopment of concavities on the lower borders of the vertebral bodies, andincrease of the anterior portion and of the total height of these vertical bodies,causing changes in their shape, changing from a wedge shape to a rectangularshape and later, to a square, and at the end of development presenting apredominance of height over width; the vertebral maturity indicators are thesame for males and females. The difference lies in the fact that each stage ofvertebral development occurred earlier in females than in males.Biological, osseous or skeletal age and skeletal maturation are synonyms usedto describe maturation stages in humans, i.e., the degree of development ofossification on the bone. All changes in bones during growth can be observed