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Ossification patterns of the C1 (atlas) and C2 (axis) vertebrae children
Mehmet Cingoz1, Mostafa Shehata2, Burak Kandemirli3
1Basaksehir Cam and Sakura City Hospital, Radiology Department, Istanbul, Turkey.
Insights
Pediatric C1 and C2 vertebrae ossification and synchondrosis fusion progress with age. This study details normal timelines to help distinguish injuries from developmental variations in young children.
Area of Science:
- Pediatric Radiology
- Pediatric Orthopedics
- Anatomy
Background:
- Accurate assessment of pediatric cervical spine injuries requires understanding normal vertebral development.
- Ossification patterns and synchondrosis fusion timelines of the C1 (atlas) and C2 (axis) vertebrae vary significantly in early childhood.
- Differentiating normal developmental variations from traumatic injuries is crucial for appropriate clinical management.
Purpose of the Study:
- To retrospectively assess ossification patterns and synchondrosis fusion timelines of the C1 and C2 vertebrae in children aged 0-72 months.
- To provide a reference guide for evaluating incompletely fused synchondrosis in pediatric patients.
- To aid in distinguishing traumatic injuries from normal developmental variations in the pediatric cervical spine.
Main Methods:
- Analysis of 432 CT examinations of children aged 0-72 months.
- Evaluation of ossification centers and synchondroses of the atlas (C1) and axis (C2) based on age.
- Assessment of visibility and fusion status of specific anatomical landmarks.
Main Results:
- Complete anterior arch ossification of the atlas increased with age, from 11.1% (0-12 months) to 97.3% (61-72 months).
- Patency of the ventrolateral synchondrosis of the atlas decreased from 100% (0-12 months) to approximately 30% (61-72 months).
- Subdental and neurocentral synchondroses of the axis showed decreasing patency with age, while apicodental synchondrosis remained highly patent.
Conclusions:
- Findings establish normal ossification patterns and fusion timelines for C1 and C2 vertebrae in young children.
- This data improves the ability to differentiate normal developmental variations from potential traumatic injuries.
- The study serves as a valuable resource for radiologists and clinicians evaluating pediatric cervical spine imaging.
Purpose:
This retrospective study aimed to assess ossification patterns and synchondrosis fusion timelines of the C1 and C2 vertebrae in pediatric age group, to help differentiate injuries from normal variations and serve as a guide when evaluating incompletely fused synchondrosis.
Materials And Methods:
The study analyzed 432 CT examinations of children aged 0-72 months, conducted at a single institution between January 2010 and January 2018. The focus was assessment of the visibility and fusion of the three ossification centers and three synchondroses of the atlas, and six ossification centers and four synchondroses of the axis, based on age.
Results:
Complete ossification of the anterior arch of the atlas was observed in 60.4 % of patients, increasing with age from 11.1 % in the 0-12 months age group to 97.3 % in the 61-72 months age group. Patency of the ventrolateral synchondrosis of the atlas decreased from 100 % in the 0-12 months age group to around 30 % in the 61-72 months age group. Subdental synchondrosis and neurocentral synchondrosis of the axis were patent in 47.0 % and 50.6 % of patients, respectively, both decreasing with age. The apicodental synchondrosis of the axis remained mostly patent (98.1 %). Overall, there was a trend of decreasing patency in synchondroses and increasing ossification with advancing age.
Conclusion:
These findings provide a better understanding of normal ossification patterns and timelines, facilitating the accurate distinction between normal variations and traumatic injuries.
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