Morphometric changes at the craniocervical junction during childhood

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Current understanding of how the pediatric craniocervical junction develops remains incomplete. Measurements of anatomical relationships at the craniocervical junction can influence clinical and surgical decision-making. The purpose of this analysis was to quantitatively define clinically relevant craniocervical junction measurements in a population of children with CT scans that show normal anatomy.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>A total of 1458 eligible patients were identified from children between 1 and 18 years of age who underwent cervical spine CT scanning at a single institution. Patients were separated by both sex and age in years into 34 groups. Following this, patients within each group were randomly selected for inclusion until a target of 15 patients in each group had been reached. Each patient underwent measurement of the occipital condyle–C1 interval (CCI), pB–C2, atlantodental interval (ADI), basion-dens interval (BDI), basion-opisthion diameter (BOD), basion-axial interval (BAI), dens angulation, and canal diameter at C1. Mean values were calculated in each group. Each measurement was performed by two teams and compared for intraclass correlation coefficient (ICC).</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>The data showed that CCI, ADI, BDI, and dens angulation decrease in magnitude throughout childhood, while pB–C2, PADI, BAI, and BOD increase throughout childhood, with an ICC of fair to good (range 0.413–0.912). Notably, CCI decreases continuously on coronal CT scans, whereas on parasagittal CT scans, CCI does not decrease until after age 9, when it shows a continuous decline similar to measurements on coronal CT scans.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>These morphometric analyses establish parameters for normal pediatric craniocervical spine growth for each year of life up to 18 years. The data should be considered when evaluating children for potential surgical intervention.</jats:p></jats:sec>

Increase in clivo-axial angle is associated with clinical improvement in children undergoing occipitocervical fusion for complex Chiari malformation: patient series

“…An analysis of the morphometric properties of the nonpathological craniocervical junction has shown that the BAI increases as a pediatric patient ages. 11 In a similarly aged cohort in this work, the normal average value of BAI was 4.6 mm, 11 which is the same as our preoperative value in this age range. Postoperatively, the BAI increased significantly to 8.2 mm, which could be attributed to increased mobility of the craniocervical junction in this age group.…”

“…We measured five morphometric parameters based on National Institutes of Health/National Institute of Neurological Disorders and Stroke Chiari malformation common data elements registry 15 and analysis of the nonpathological pediatric craniocervical junction carried out by Bapuraj et al 11 These parameters were pB-C2 line, atlantodental interval (ADI), basion-dens interval (BDI), basion-axial interval (BAI), and canal diameter at the level of C1. A sixth parameter (cliovoaxial angle [CXA]) was added based on an analysis of pediatric patients with OCF by Bollo et al 16 The measurements were based on computed tomography (CT) and magnetic resonance imaging (MRI) carried out closest to the date of surgery and on imaging approximately 3 months after surgery.…”

“…Dynamics and morphometrics of the pediatric OC junction changes as a child ages. [11][12][13] We felt it was important to look at age-stratified data when considering these properties in relation to CCI in patients with complex Chiari malformation who have received PFD and OCF. Thus, we stratified our cohort into three age groups.…”

“…We also analyze morphometric properties based on age stratification because the normal craniocervical junction changes as pediatric patients age. [11][12][13] Our main goals in this study were to answer the following questions: (1) What are the clinical outcomes after OCF in pediatric patients with complex Chiari malformation? (2) Does age stratification make a difference in OCF surgery outcomes?…”

Evaluation of using the Anderson-Montesano and the Tuli classifications in pediatric patients with occipital condyle fractures

“…The length of the leg after the epiphyseal fusion is stable, but the small increment is still observed in sitting height, meaning that for the last couple centimeters of height increase, the increase in spinal cord length is responsible [26,27]. Also the morphometric parameters of the cranio-cervical junction change during the whole childhood [28]. As Bapuraj et al showed, the evolution of the cranio-cervical junction does not stop with the intense growth cessation, but proceeds to the age of 18 years, as the spinal cord is still growing.…”