Surgically related upper cervical spine canal anatomy in children

Area of Science:

• Pediatric Radiology
• Spinal Anatomy
• Neurosurgery

Background:

• Accurate C1 sagittal anatomy is crucial for pediatric spinal assessment.
• Understanding normal growth patterns aids in diagnosing spinal stenosis.
• Previous studies lack detailed pediatric C1 dimensional data.

Purpose of the Study:

• To precisely define the sagittal anatomy of the C1 region in children.
• To analyze growth patterns of the C1 bony canal, spinal cord, and surrounding spaces.
• To evaluate the applicability of Steel's rule of thirds in pediatric C1 anatomy.

Main Methods:

• Retrospective analysis of 121 pediatric upper spine MRI scans.
• Measurement of spinal cord, bony canal, space available for the cord (SAC), and atlanto-dens interval (ADI).
• Statistical analysis to determine growth trends and correlations.

Main Results:

• Significant accelerated growth observed in C1 canal, dens+ADI, and SAC during the first four years post-birth.
• Steel's rule of thirds demonstrated approximate validity throughout childhood.
• Neonates exhibit an average SAC diameter of 12.4 mm, below the 13 mm threshold for relative stenosis.

Conclusions:

• The C1 region undergoes rapid development in early childhood.
• Neonatal SAC dimensions may be misinterpreted as stenosis using standard adult criteria.
• Establishment of pediatric-specific normative data for C1 anatomy is essential.