Wedging of C-3 in infants and children: usually a normal finding and not a fracture

The vertebral body configurations of the cervical spine from C-3 to C-7 were analyzed in 481 pediatric patients to ascertain how often anterior tapering or wedging of C-3 (either of which may suggest a compression fracture) occurred, how often this configuration occurred at other levels, and why it occurred. The lateral radiographs of the cervical spine were retrospectively analyzed, and the configuration of the vertebral bodies was classified as type 1 (oval and immature), 2 (a vertebral body with a round anterior superior corner), 3 (anteriorly tapered), or 4 (rectangular, with a mature appearance). The patients were divided into four age groups: 0-3, 4-7, 8-12, and 13-19 years. The findings confirmed that cervical vertebral bodies early in infancy are oval and become more rectangular with age but that at C-3 normal wedging can persist. It is postulated that in some children chronic, exaggerated hypermobility causes chronic, repetitive impaction of the vertebral body of C-3 by C-2, a subclinical insult that could impair normal ossification or transformation of cartilage to bone at this site.