Background: The radiographic anatomy of the cervical spine in children is c
omplex and can be difficult to interpret. The present study was undertaken
to document radiographically the growth and development of the cervical spi
ne in a prospective, longitudinal manner and to establish standard radiogra
phic measurements on the basis of findings in patients who were followed se
rially 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 dev
elopment of the atlantodens interval, the diameter of the spinal canal, the
Torg ratio, the height and width of the second through fifth cervical vert
ebral bodies, the height of the dens, and the ossification of the first cer
vical vertebra were assessed on serial radiographs made from the age of thr
ee months until skeletal maturity.
Results: Serial measurements of the atlantodens interval, the anteroposteri
or 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 present
ed in tabular and graphic forms. The median Torg ratio was 1.47 for both ma
les 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% o
f the children by the age of one year. Closure of the synchondroses was com
pleted 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 longitudina
lly from before the age of three years through the course of growth and dev
elopment until skeletal maturity.