Growth and development of the pediatric cervical spine documented radiographically

Background: The radiographic anatomy of the cervical spine in children is c omplex and can be difficult to interpret. The present study was undertaken to document radiographically the growth and development of the cervical spi ne in a prospective, longitudinal manner and to establish standard radiogra phic measurements on the basis of findings in patients who were followed se rially from the age of three months until skeletal maturity. Methods: The radiographic resources of the Cleveland Study of Normal Growth and Development (Bolton-Brush Collection, Cleveland, Ohio) were reviewed. From this large database, we identified fifty boys and forty-six girls who had a sufficient number of radiographs of the cervical spine for inclusion in our study. With use of a computerized image analyzer, the growth and dev elopment of the atlantodens interval, the diameter of the spinal canal, the Torg ratio, the height and width of the second through fifth cervical vert ebral bodies, the height of the dens, and the ossification of the first cer vical vertebra were assessed on serial radiographs made from the age of thr ee months until skeletal maturity. Results: Serial measurements of the atlantodens interval, the anteroposteri or diameter of the cervical canal, the height and anteroposterior width of the cervical vertebral bodies, and the height of the dens, made in normal, healthy children from the age of three months to fifteen years, are present ed in tabular and graphic forms. The median Torg ratio was 1.47 for both ma les and females primarily, and it reached values of 1.06 for males and 1.10 for females by maturity. The anterior arch of the first cervical vertebra had ossified in 33% of the children by the age of three months and in 81% o f the children by the age of one year. Closure of the synchondroses was com pleted in all children by the age of three years. Conclusions: The measurements presented in the current study are important because they are the first, as far as we know, to document the radiographic parameters of the cervical spine in children who were followed longitudina lly from before the age of three years through the course of growth and dev elopment until skeletal maturity.