Radiographic Evaluation of Scoliosis in Pediatric, Adolescent, and Young Adult Patients: Associations Between Curve Severity, Localization, and Skeletal Maturity

Background/Objectives: The vertebral column is exposed to significant mechanical loads, exceeding 8000 N at certain levels due to bipedal posture and locomotion. These forces may contribute to structural alterations during growth. Scoliosis is among the most common structural spinal conditions in children and adolescents, with reported prevalence ranging from 0.5% to 5.2%. Our study aims to evaluate the radiographic characteristics of scoliosis in pediatric, adolescent and young adult patients and to analyze associations between curve severity and anatomical and developmental parameters. Methods: This retrospective cross-sectional study included 233 patients (152 females, 81 males) examined between August and October 2023. Cobb angle, curve localization, curve direction, Risser stage, and spina bifida occulta were assessed. Associations between variables were analyzed using chi-square and Fisher’s exact tests, and multivariable linear and ordinal regression models. Results: Scoliosis (Cobb angle ≥ 10°) was identified in 62.2% of patients within this referral cohort. A statistically significant association was observed between curve localization and scoliosis severity (p = 0.007), with thoracic curves being present more frequently with higher Cobb angles. No statistically significant associations were found between scoliosis severity and sex or curve direction. Spina bifida occulta was detected in 11.7% of scoliotic patients. Skeletal maturity followed expected age-related patterns. In multivariable ordinal logistic regression across the entire cohort, primary thoracic curve localization (aOR = 4.64, p < 0.001), female sex (aOR = 3.06, p < 0.001), and older age (aOR = 1.18, p = 0.002) were independently associated with higher scoliosis severity categories, whereas Risser stage and spina bifida occulta were not. In subgroup multivariable linear regression restricted to thoracic curves, higher Risser stage (β = −3.11°/stage, p = 0.041) and older age (β = 2.12°/year, p = 0.013) were independently associated with continuous Cobb angle magnitude. Conclusions: Scoliosis severity is associated with anatomical curve localization and skeletal maturity demonstrates age-appropriate ossification patterns. These findings support the value of integrated radiographic assessment, including Cobb angle evaluation and Risser staging, in the diagnostic work-up of pediatric, adolescent, and young adult scoliosis.