Reliability of cervical vertebral maturation compared to hand-wrist for skeletal maturation assessment in growing subjects: A systematic review

BACKGROUND: Radiographic methods to assess skeletal maturity (SM) have a key role in adolescent idiopathic scoliosis (AIS) management, allowing to predict risk of spinal curve progression. Cervical vertebral maturation (CVM) has been recently introduced as an alternative tool to assess skeletal maturity; however, its clinical role is still debated. OBJECTIVE: This systematic review aimed to investigate the reliability of CVM in the SM assessment of growing subjects, comparing it to hand wrist maturation (HVM). METHODS: PubMed, Scopus, and Web of Science databases were systematically searched from inception until 31st December 2020 to identify observational studies presenting: growing subjects as participants; CVM methods as intervention; HVM methods as comparator; reliability for SM assessment as outcome. A 10-item quality tool has been used to assess study quality. RESULTS: Out of 205 papers, 12 papers were included in the data synthesis. We classified 10 studies (83.3%) as medium-quality studies and 2 studies (16.7%) as high-quality studies. Eight studies reported a significant correlation between CVM Baccetti and different HWM methods. CONCLUSION: Taken together, these findings suggested that CVM might be considered as reliable SM assessment method compared to HWM in growing subjects. However, further studies are warranted to confirm these findings.