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Developmental Morphology and Ossification Patterns of the C1 Vertebra

Rao, Raj D., MD1; Tang, Shujie, MD1; Lim, Chi, MD1; Yoganandan, Narayan, PhD1

doi: 10.2106/JBJS.L.01035
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Background: The first cervical vertebra (C1) is a unique ring-shaped structure and is largely cartilaginous at birth. Our objectives were to retrospectively analyze the age of closure of the synchondroses and determine age-dependent morphological characteristics of the C1 vertebra using computed tomographic (CT) scans.

Methods: Helical CT scans were made in fifty-four children as part of routine imaging of patients presenting to the emergency room with head injury, to exclude cervical spine trauma. Axial and sagittal reconstruction images of the C1 ring were analyzed for widths of the anterior and posterior synchondroses, outer and inner anteroposterior diameters, outer and inner transverse diameters, inner area of the spinal canal at C1, and heights of the anterior and posterior arches. Variations in these parameters were evaluated in age groups from infancy to eighteen years.

Results: As ossification progressed, the widths of the anterior neurocentral and posterior synchondroses decreased with increasing age. Closure of the posterior synchondrosis was complete in all by thirty-six months, except in one fifty-five-month-old subject in whom the posterior synchondrosis was open. Closure of the anterior synchondrosis was generally found after thirty-six months. Growth of the mean outer and inner anteroposterior diameters, mean outer transverse diameter, and increase in canal area occurred with age up to the three to six-year group, following which measurements increased minimally or stayed relatively constant. The inner transverse diameter was largely unchanged from birth to maturity and appeared to be independent of age. Anterior and posterior ring heights showed a similar distribution, with an increase up to the nine to twelve-year age group, and relatively constant values thereafter.

Conclusions and Clinical Relevance: Data from this retrospective review of fifty-four CT scans of the cervical spine, weighted toward the youngest population, assist in understanding the age-dependent osseous anatomy and biomechanical stability of the C1 vertebra in the growing child, help to distinguish fractures from incomplete ossification, and help to formulate decisions on the use of internal fixation of C1 in the growing child.

1Departments of Orthopaedic Surgery (R.D.R., S.T., C.L., and N.Y.) and Neurosurgery (R.D.R. and N.Y.), Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226

Copyright © 2013 by The Journal of Bone and Joint Surgery, Incorporated
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