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Abstract
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BACKGROUND: Only a small number of studies have offered normative data for the upper cervical spine in children and with some variation in findings.
OBJECTIVE: The aim of this study was to determine normal values for upper cervical spine measurements used in the assessment of upper cervical spine trauma in the pediatric population.
METHODS: One-hundred computed tomographic images of the cervical spine of children aged ≤16 years were included for analysis. All children were cleared of spinal injury. Anterior atlanto-dens interval (ADI), posterior atlanto-dens interval (PADI), basion-dens interval (BDI), Powers ratio, condylar-C1 interval (CCI), and lateral mass interval (LMI) were measured on the relevant sagittal or coronal images. Measurements for CCI and LMI were taken on each side.
RESULTS: Mean age was 111 months (range 11-196 months). Sixty-two were male. Mean values (and ranges) of the measurements were as follows: BDI: 7.1 mm (3.6-12.2); ADI 2.8 mm (0.8-4.8); PADI 18.7 mm (14.1-23.2); Powers ratio 0.72 (0.59-1.0); CCI 2.0 and 2.0 (0.5-4.2); and LMI 3.2 and 3.3 mm (1.7-4.8). BDI (r = -0.488), ADI (r = -0.201), PADI (r = 0.264), and CCI (r = -0.468 and -0.454) all showed significant correlation with age. The Powers ratio was the most stable measurement across all age groups.
CONCLUSIONS: Normal values were reported from a local pediatric population with a wide age range. Most values correlate with age to a degree, and so normal values may vary throughout childhood. A multicenter study is desirable to advance knowledge in this field.
CLINICAL RELEVANCE: Current radiographic measures used to assess for possible ligamentous injury in the pediatric upper cervical spine correlate with age. Caution must be held when analyzing the upper cervical spine across a range of age groups in children.
Language: en |