Asymmetry of the Odontoid Lateral Mass Interval in Pediatric Trauma CT: Do We Need to Investigate Further?

Abstract

BACKGROUND AND PURPOSE:Odontoid lateral mass interval asymmetry can be within the normal spectrum or the result of traumatic atlantoaxial injury. We sought to set radiographic guidelines for further investigation of odontoid lateral mass interval asymmetry in cervical spine CT studies of pediatric trauma patients.

Evaluation of lateral atlantodental interval asymmetry in the pediatric age group: normative values

“…The overall mean for LADI asymmetry was 0.09 ± 1.23 mm (range -6.05 to 4.87 mm). Our results are consistent with those of CT-based LADI asymmetry reported by Borders et al 3 and Eran et al 9 (1.38 ± 1.26 mm and 1.4 ± 0.7 mm, respectively), confirming the validity of our data.…”

“…The dilemma concerning whether additional workup is needed for a child with LADI asymmetry is encountered frequently in busy emergency departments and trauma centers. 9 Mounting evidence seems to suggest that LADI asymmetry can be a normal variant in adults 2,5, 9, 11-13, 17,24 and children, 3,9 or it can be related to head positioning. 9 On the contrary, asymmetry of LADI can also suggest ligamentous cervical spine injury, which, if left undiagnosed or untreated, may lead to severe and catastrophic consequences.…”

“…9 Mounting evidence seems to suggest that LADI asymmetry can be a normal variant in adults 2,5, 9, 11-13, 17,24 and children, 3,9 or it can be related to head positioning. 9 On the contrary, asymmetry of LADI can also suggest ligamentous cervical spine injury, which, if left undiagnosed or untreated, may lead to severe and catastrophic consequences. 9,18,19,22 It is therefore important to establish normative values for LADI asymmetry.…”

“…9 On the contrary, asymmetry of LADI can also suggest ligamentous cervical spine injury, which, if left undiagnosed or untreated, may lead to severe and catastrophic consequences. 9,18,19,22 It is therefore important to establish normative values for LADI asymmetry. CT morphometric studies of the cervical spine are more complex in children because of its dynamic and growing nature.…”

“…1,4,6,8,20,21 It is not sufficient to simply establish a range of normal values; these normal values must be analyzed and stratified by age ranges. 14,23 In a small series of 56 "noninjured" children, Eran et al 9 did not examine the effect of age or sex on LADI asymmetry normative values.…”