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Updated: Jul 11, 2026
Precision Measurements and Parametric Models of Vertebral Endplates
Published on: September 17, 2019
Growth and development of the pediatric cervical spine documented radiographically
J C Wang1, S L Nuccion, J E Feighan
1Department of Orthopaedic Surgery, University of California at Los Angeles School of Medicine, 90095-6902, USA.
Insights
This study establishes standard radiographic measurements for pediatric cervical spine development. It provides crucial data on cervical spine growth from infancy to skeletal maturity for accurate interpretation.
Area of Science:
- Pediatric Radiology
- Orthopedic Development
- Anatomy
Background:
- Pediatric cervical spine anatomy is complex and challenging to interpret radiographically.
- Establishing normative data is essential for accurate diagnosis and monitoring.
Purpose of the Study:
- To prospectively document the radiographic growth and development of the pediatric cervical spine.
- To establish standard radiographic measurements from three months to skeletal maturity.
Main Methods:
- Utilized serial radiographs from the Cleveland Study of Normal Growth and Development (Bolton-Brush Collection).
- Assessed atlantodens interval, spinal canal diameter, Torg ratio, vertebral body dimensions, and dens height using computerized image analysis.
- Included 50 boys and 46 girls followed from three months to skeletal maturity.
Main Results:
- Presents serial measurements of key cervical spine parameters in tabular and graphic forms.
- Median Torg ratio reached 1.06 (males) and 1.10 (females) by maturity.
- Anterior arch ossification occurred in 33% by three months and 81% by one year; synchondroses closed by three years.
Conclusions:
- This study provides the first longitudinal radiographic documentation of pediatric cervical spine parameters.
- The established measurements are vital for understanding normal growth and development.
- Offers a foundational dataset for interpreting pediatric cervical spine radiographs.
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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