The ACDF procedure itself can induce regional slope change (C5-s and C7-s) directly at the surgical level and can also influence upper cervical slope change (C1-s and C2s) indirectly. Then the change in the upper cervical spine can induce a change in the St-CVA and spino-cranial angle (SCA).

ObjectiveThe purpose of this study was to investigate morphological change at the craniovertebral junction (CVJ) region using computed tomography.MethodsA total of 238 patients were included in this study, and mean age was 47.8±21.3 months. Spinal canal diameter, Power's ratio, McRae line, antero-posterior C1 ring height, atlantoaxial joint space, C2 growth, epidural space from the dens (M-PB-C2) and longitudinal distance (basion to C2 lower margin, B-C2) were measured. The mean value of each parameter was assessed for individual age groups. The cohorts were then divided into three larger age groups : infancy (I) (≤2 years), very early (VE) childhood (2-5 years) and early (E) childhood (5≥ years).ResultsSpinal canal diameter increased with age; however, this value did not increase with statistical significance after VE age. A significant age-related difference was found for all C2 body and odontoid parameters (p<0.05). Mean McRae line was 8.5, 8, and 7.5 mm in the I, VE, and E groups, respectively. The M-PB-C2 line showed up-and-down dynamic change during early pediatric periods.ConclusionExpansion of the spinal canal was restricted to the very early childhood period (less than 5 years) in the CVJ region; however, the C2 body and odontoid process increased continuously with age. The above results induced a dynamic change in the M-PB-C2 line. Although C2 longitudinal growth continued with age, the McRae line showed relatively little change.

The direct OC screw fixation was not possible in a considerable number of cases due to the limited space and the position of the VA regardless of age group. Only about one quarter (21-24 %) of all patients was affordable to place the direct OC screw bilaterally. There was more space available to place the direct OC screw when the angle of the upper cervical spine is more kyphotic.

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