Cervical vertebral maturation as a biologic indicator of skeletal maturity

Angle Orthod. 2012 Nov;82(6):1123-31. doi: 10.2319/103111-673.1. Epub 2012 Mar 14.


Objective: To identify and review the literature regarding the reliability of cervical vertebrae maturation (CVM) staging to predict the pubertal spurt.

Materials and methods: The selection criteria included cross-sectional and longitudinal descriptive studies in humans that evaluated qualitatively or quantitatively the accuracy and reproducibility of the CVM method on lateral cephalometric radiographs, as well as the correlation with a standard method established by hand-wrist radiographs.

Results: The searches retrieved 343 unique citations. Twenty-three studies met the inclusion criteria. Six articles had moderate to high scores, while 17 of 23 had low scores. Analysis also showed a moderate to high statistically significant correlation between CVM and hand-wrist maturation methods. There was a moderate to high reproducibility of the CVM method, and only one specific study investigated the accuracy of the CVM index in detecting peak pubertal growth.

Conclusions: This systematic review has shown that the studies on CVM method for radiographic assessment of skeletal maturation stages suffer from serious methodological failures. Better-designed studies with adequate accuracy, reproducibility, and correlation analysis, including studies with appropriate sensitivity-specificity analysis, should be performed.

Publication types

  • Review
  • Systematic Review
  • Validation Study

MeSH terms

  • Adolescent
  • Adolescent Development / physiology
  • Age Determination by Skeleton / methods*
  • Bone Development / physiology
  • Cervical Vertebrae / diagnostic imaging
  • Cervical Vertebrae / growth & development*
  • Child
  • Female
  • Hand / diagnostic imaging*
  • Humans
  • Longitudinal Studies
  • Male
  • Reproducibility of Results
  • Wrist / diagnostic imaging*