Two novel parameters to evaluate the influence of the age and gender on the anatomic relationship of the atlas and axis in children no more than 8 years old: imaging study

  • Long Wu
  • Yu Jin
  • Xiang-Yang Wang
  • Bi-Dong Fang
  • Ai-Min Wu
  • Sheng Wang
  • Cheng-Long Xie
  • Zhong-Ke LinEmail author
Spinal Neuroradiology



Because of the complex cervical vertebral embryology and some normal variations, the atlantoadental interval (ADI) was not suitable for the evaluation of the anatomic relationship between the atlas and axial in children less than 2 years old. And the influence of the age and gender on the anatomic relationship between atlas and axial in children was still unclear. Two novel parameters, atlas-axis anteroposterior distance (AAAD) and atlas-axis lateral distance (AALD), were invented to evaluate the anatomic relationship between the atlas and axis in the children no more than 8 years old with different age and gender.


Cross-sectional computed tomography (CT) scans of the atlantoaxial joint for 140 randomly selected pediatric patients no more than 8 years old were analyzed. On the ideal CT reconstruction images, AAAD, AALD, atlantoaxial lateral bending angle (AALB), and atlantoaxial rotation angle (AARA) were measured.


There was no statistically significant difference between the mean AAAD in different age and gender groups. The 99% confidence interval for AAAD was 7.12–7.82 mm. There was no significant correlation between AAAD and AALB/AARA and AALD and AALB/AARA.


The AAAD was less than 7.12 mm or much than 7.82 mm that suggested a possible instability in the atlantoaxial joint and could help the diagnosis of the atlantoaxial instability in children no more than 8 years old. There was no difference between the mean AAAD of pediatric patients no more than 8 years old in different age and gender groups.


Atlantoaxial joint Pediatric Imaging Computed tomography 



anterior atlas arch


atlas-axis anteroposterior distance


atlantoaxial instability


atlantoaxial lateral bending angle


atlas-axis lateral distance


atlantoaxial rotation angle


atlantodental interval


computed tomography


posterior atlas arch


Funding information

This study was funded by the Science and Technology Program of Wenzhou China (Grant No. Y20180031), the Zhejiang Provincial Natural Science Foundation of China (Grant No. LY14H060008) and the National Natural Science Foundation of China (Grant No. 81572214).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Long Wu
    • 1
    • 2
  • Yu Jin
    • 1
    • 2
  • Xiang-Yang Wang
    • 1
    • 3
  • Bi-Dong Fang
    • 3
    • 4
  • Ai-Min Wu
    • 1
    • 3
  • Sheng Wang
    • 1
    • 3
  • Cheng-Long Xie
    • 1
    • 2
  • Zhong-Ke Lin
    • 1
    • 3
    Email author
  1. 1.Department of OrthopaedicThe Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical UniversityWenZhouChina
  2. 2.The Second School of MedicineWenzhou Medical UniversityWenZhouChina
  3. 3.Zhejiang Provincial Key Laboratory of OrthopaedicsWenZhouChina
  4. 4.Radiology Departmentthe Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical UniversityWenZhouChina

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