J Korean Neurosurg Soc.  2015 Apr;57(4):276-282. 10.3340/jkns.2015.57.4.276.

Quantification of Pediatric Cervical Spine Growth at the Cranio-Vertebral Junction

Affiliations
  • 1Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea. kjtns@olmh.cuk.ac.kr
  • 2Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea.

Abstract


OBJECTIVE
The purpose of this study was to investigate morphological change at the craniovertebral junction (CVJ) region using computed tomography.
METHODS
A total of 238 patients were included in this study, and mean age was 47.8+/-21.3 months. Spinal canal diameter, Power's ratio, McRae line, antero-posterior C1 ring height, atlantoaxial joint space, C2 growth, epidural space from the dens (M-PB-C2) and longitudinal distance (basion to C2 lower margin, B-C2) were measured. The mean value of each parameter was assessed for individual age groups. The cohorts were then divided into three larger age groups : infancy (I) (< or =2 years), very early (VE) childhood (2-5 years) and early (E) childhood (5> or = years).
RESULTS
Spinal canal diameter increased with age; however, this value did not increase with statistical significance after VE age. A significant age-related difference was found for all C2 body and odontoid parameters (p<0.05). Mean McRae line was 8.5, 8, and 7.5 mm in the I, VE, and E groups, respectively. The M-PB-C2 line showed up-and-down dynamic change during early pediatric periods.
CONCLUSION
Expansion of the spinal canal was restricted to the very early childhood period (less than 5 years) in the CVJ region; however, the C2 body and odontoid process increased continuously with age. The above results induced a dynamic change in the M-PB-C2 line. Although C2 longitudinal growth continued with age, the McRae line showed relatively little change.

Keyword

Craniovertebral junction; Computed tomography; Childhood

MeSH Terms

Atlanto-Axial Joint
Cohort Studies
Epidural Space
Humans
Odontoid Process
Spinal Canal
Spine*

Figure

  • Fig. 1 Techniques for measuring the occipital area. a : occiput spinal canal antero-posterior diameter, b : McRae line.

  • Fig. 2 Techniques for measuring in C1. a : C1 anterior arch height, b : C1 posterior arch height, c : C1 spinal canal antero-posterior diameter (C1-AP), d : occiput-C1 posterior arch distance (O-C1 interval), e : atlantoaxial (AA) joint space.

  • Fig. 3 Measuring techniques in C2. a : odontoid process height, b : odontoid process antero-posterior diameter, c : C2 body AP diameter, d : C2 body height, e : B-C2 distance, f : modified-(perpendicular basion-C2 line).


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