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The different grades of the Risser sign give a measure of bone maturity and thus of the skeletal growth to be expected. In Europe, a scale ranging from Risser 0 to Risser 5 defines the grades from beginning ossification to complete fusion of the apophysis to the iliac bone. In the USA, 4 grades are defined.
Among scoliosis specialists, the Risser sign 9 is still the most popular and reliable method used to establish bone maturity. 4 The Risser grading scale rates the child's skeletal maturity on a continuum from zero to five. In girls and boys, rapid growth occurs during Risser sign zero to one.