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The Journal of Bone and Joint Surgery (American) 83:1212-1218 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.

Growth and Development of the Pediatric Cervical Spine Documented Radiographically

Jeffrey C. Wang, MD, Stephen L. Nuccion, MD, John E. Feighan, MD, Brad Cohen, MD, Frederick J. Dorey, PhD and Peter V. Scoles, MD

Investigation performed at the Department of Orthopaedic Surgery, University of California at Los Angeles School of Medicine, Los Angeles, California, and the Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, Ohio
Jeffrey C. Wang, MD
Stephen L. Nuccion, MD
Frederick J. Dorey, PhD
Department of Orthopaedic Surgery, University of California at Los Angeles School of Medicine, Box 956902, Los Angeles, CA 90095-6902

John E. Feighan, MD
Brad Cohen, MD
Department of Orthopaedic Surgery, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106

Peter V. Scoles, MD
National Board of Medical Examiners, 3750 Market Street, Philadelphia, PA 19104-3190

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: The radiographic anatomy of the cervical spine in children is complex and can be difficult to interpret. The present study was undertaken to document radiographically the growth and development of the cervical spine in a prospective, longitudinal manner and to establish standard radiographic measurements on the basis of findings in patients who were followed serially 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 development of the atlantodens interval, the diameter of the spinal canal, the Torg ratio, the height and width of the second through fifth cervical vertebral bodies, the height of the dens, and the ossification of the first cervical vertebra were assessed on serial radiographs made from the age of three months until skeletal maturity.

Results: Serial measurements of the atlantodens interval, the anteroposterior 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 presented in tabular and graphic forms. The median Torg ratio was 1.47 for both males 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% of the children by the age of one year. Closure of the synchondroses was completed 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 longitudinally from before the age of three years through the course of growth and development until skeletal maturity.


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