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

• Lee HJ
• Kim JT
• Shin MH
• Choi DY
• Hong JT

• KMID: 1956426
• DOI: http://doi.org/10.3340/jkns.2015.57.4.276

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

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

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  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.

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  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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