Comparison of spheno-occipital synchondrosis closure, cervical vertebrae maturation and hand-wrist maturation as skeletal maturation indicators

Abstract

Aim: To examine the correlation between three skeletal maturation indicators: hand-wrist maturation, cervical vertebrae maturation and the spheno-occipital synchondrosis closure. Methods: The hand-wrist radiographs and images of cervical vertebrae and the spheno-occipital synchondrosis (extracted from CBCTs) of 61 patients were graded for skeletal maturation by three raters on two different dates. Their stages were compared to analyze the agreement between the three skeletal maturation markers. The reliability of the staging of the three analyses was also studied. Results: The hand-wrist maturation analysis had the highest intra-rater (ĸ= 0.895) and inter-rater reliability (Kendall’s coefficient = 0.972), while the spheno-occipital’s reliability was the lowest (intra-rater reliability ĸ = 0.642; inter-rater reliability Kendall’s coefficient = 0.886). The skeletal maturation indicators that agreed most closely were the hand-wrist maturation and the spheno-occipital synchondrosis (ĸ = 0.5079). Conclusions: The three skeletal maturation analyses studied are related but not inter-changeable. More clear definitions of the staging of the analyses and calibrations of the analyses are needed to improve reliability. A clinician should rely on multiple markers to make decisions regarding a patient’s growth potential.