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Quantification of pediatric cervical growth: anatomical changes in the sub-axial spine
Ho Jin Lee1, Jung Jae Lee2, Jae Taek Hong3
1Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Incheon, Korea.
Insights
Pediatric sub-axial cervical spine growth shows minimal axial expansion and height increase. The Torg ratio (TR) decreases with age, and while vertical length is similar between genders, axial dimensions vary.
Area of Science:
- Pediatric Radiology
- Spine Anatomy
- Biomechanical Engineering
Background:
- Understanding pediatric cervical spine development is crucial for diagnosing and managing spinal conditions.
- Normal values for sub-axial cervical spinal canal and vertebral body dimensions are essential for accurate assessment.
- Computed tomography (CT) is a key imaging modality for evaluating pediatric spinal anatomy.
Purpose of the Study:
- To establish normal values for pediatric sub-axial cervical spinal canal and vertebral body growth patterns.
- To analyze the Torg ratio (TR) and sub-axial cervical spine angle (C3-7) in children under 10 years old.
- To investigate gender-based differences in pediatric cervical spine dimensions.
Main Methods:
- Retrospective analysis of CT scans from 318 patients under 10 years old.
- Measurement of vertebral body and spinal canal dimensions across four age groups.
- Calculation of the Torg ratio (TR) and C3-7 angle to assess spinal canal width and curvature.
Main Results:
- Minimal axial expansion (2.9 mm) and height growth (3.4 mm) were observed in the sub-axial cervical spine.
- Spinal canal increments (1.8 mm) were smaller than vertebral body dimensions.
- Mean Torg ratio values ranged from 1.02 to 1.05, with a mean C3-7 angle of 7.9°.
Conclusions:
- The upper sub-axial spinal canal grows continuously after age 8, unlike the lower segments.
- The Torg ratio significantly decreases after late childhood.
- While vertical cervical vertebral length shows no significant gender difference, axial dimensions of the vertebral body and spinal canal vary between boys and girls.
Objective:
In order to provide normal values of the pediatric sub-axial cervical spinal canal and vertebral body growth pattern using computed tomographic scans, a total of 318 patients less than 10 years old were included.
Methods:
The growth of the vertebral body and canal space was investigated using four different age groups. The Torg ratio (TR) was calculated and all patients were classified into a low TR group and a high TR group according to a cutoff value of 1.0. To account for spinal curvature, the C3-7 angle was measured.
Results:
Very little axial expansion and growth in height were observed (2.9 mm and 3.4 mm, respectively), and the spinal canal increments (1.8 mm) were much smaller than the dimensions of the vertebral body. The mean TR values were 1.03±0.14 at the C3 vertebral level, 1.02±0.13 at C4, 1.05±0.13 at C5, 1.04±0.13 at C6, and 1.02±0.12 at C7 in all patients. The mean sub-axial angle (C3-7) was 7.9±10.6° (range: -17-47°).
Conclusion:
The upper sub-axial spinal canal continuously increased in size compared to the lower sub-axial spine after 8 years of age. Considerable decrements in the TR was found after late childhood compared to younger ages. Generally, there were no significant differences between boys and girls in vertical length of the cervical vertebrae. However, the axial dimension of the vertebral body and the spinal canal space varied according to gender.
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