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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

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

Keywords

Atlantoaxial joint Pediatric Imaging Computed tomography 

Abbreviations

AAA

anterior atlas arch

AAAD

atlas-axis anteroposterior distance

AAI

atlantoaxial instability

AALB

atlantoaxial lateral bending angle

AALD

atlas-axis lateral distance

AARA

atlantoaxial rotation angle

ADI

atlantodental interval

CT

computed tomography

PAA

posterior atlas arch

Notes

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.

References

  1. 1.
    Yang HS, Kim KW, Oh YM, Eun JP (2017) Usefulness of titanium mesh cage for posterior C1-C2 fixation in patients with atlantoaxial instability. Medicine (Baltimore) 96:e8022.  https://doi.org/10.1097/MD.0000000000008022 CrossRefGoogle Scholar
  2. 2.
    Lustrin ES, Karakas SP, Ortiz AO, Cinnamon J, Castillo M, Vaheesan K, Brown JH, Diamond AS, Black K, Singh S (2003) Pediatric cervical spine: normal anatomy, variants, and trauma. Radiographics 23:539–560.  https://doi.org/10.1148/rg.233025121 CrossRefGoogle Scholar
  3. 3.
    Bahadur R, Goyal T, Dhatt SS, Tripathy SK (2010) Transarticular screw fixation for atlantoaxial instability-modified Magerl’s technique in 38 patients. J Orthop Surg Res 5:87.  https://doi.org/10.1186/1749-799X-5-87 CrossRefGoogle Scholar
  4. 4.
    Singh B, Cree A (2015) Laminar screw fixation of the axis in the pediatric population: a series of eight patients. Spine J 15:e17–e25.  https://doi.org/10.1016/j.spinee.2014.10.009 CrossRefGoogle Scholar
  5. 5.
    Johnson KT, Al-Holou WN, Anderson RC, Wilson TJ, Karnati T, Ibrahim M, Garton HJ, Maher CO (2016) Morphometric analysis of the developing pediatric cervical spine. J Neurosurg Pediatr 18:377–389.  https://doi.org/10.3171/2016.3.PEDS1612 CrossRefGoogle Scholar
  6. 6.
    Karwacki GM, Schneider JF (2012) Normal ossification patterns of atlas and axis: a CT study. AJNR Am J Neuroradiol 33:1882–1887.  https://doi.org/10.3174/ajnr.A3105 CrossRefGoogle Scholar
  7. 7.
    Piatt JH Jr, Grissom LE (2011) Developmental anatomy of the atlas and axis in childhood by computed tomography. J Neurosurg Pediatr 8:235–243.  https://doi.org/10.3171/2011.6.PEDS11187 CrossRefGoogle Scholar
  8. 8.
    Menezes AH (2008) Craniocervical developmental anatomy and its implications. Childs Nerv Syst 24:1109–1122.  https://doi.org/10.1007/s00381-008-0600-1 CrossRefGoogle Scholar
  9. 9.
    Junewick JJ, Chin MS, Meesa IR, Ghori S, Boynton SJ, Luttenton CR (2011) Ossification patterns of the atlas vertebra. AJR Am J Roentgenol 197:1229–1234.  https://doi.org/10.2214/AJR.10.5403 CrossRefGoogle Scholar
  10. 10.
    Zhang XB, Luo C, Li M, Zhang X, Hui H, Zeng Q, Li TY, Zhang DW, Zhang YY, Wang C, Liu CK, Liu X, Qu XY, Cao YJ, Zhou H, Weng LQ (2018) Clinical significance of imaging findings for atlantoaxial rotatory subluxation in children. Turk J Med Sci 48:332–338.  https://doi.org/10.3906/sag-1707-137 CrossRefGoogle Scholar
  11. 11.
    Rojas CA, Hayes A, Bertozzi JC, Guidi C, Martinez CR (2009) Evaluation of the C1-C2 articulation on MDCT in healthy children and young adults. AJR Am J Roentgenol 193:1388–1392.  https://doi.org/10.2214/AJR.09.2688 CrossRefGoogle Scholar
  12. 12.
    Liu K, Xie F, Wang D, Guo L, Qi Y, Tian J, Zhao B, Chhabra A (2015) Reference ranges for atlantodental interval in adults and its variation with age and gender in a large series of subjects on multidetector computed tomography. Acta Radiol 56:465–470.  https://doi.org/10.1177/0284185114530284 CrossRefGoogle Scholar
  13. 13.
    Osmotherly PG, Farrell SF, Digby SD, Rowe LJ, Buxton AJ (2013) The influence of age, sex, and posture on the measurement of atlantodental interval in a normal population. J Manip Physiol Ther 36:226–231.  https://doi.org/10.1016/j.jmpt.2013.04.004 CrossRefGoogle Scholar
  14. 14.
    Hinck VC, Hopkins CE (1960) Measurement of the atlanto-dental interval in the adult. Am J Roentgenol Radium Therapy, Nucl Med 84:945–951Google Scholar
  15. 15.
    Vanek P, Bradac O, de Lacy P, Pavelka K, Votavova M, Benes V (2017) Treatment of atlanto-axial subluxation secondary to rheumatoid arthritis by short segment stabilization with polyaxial screws. Acta Neurochir 159:1791–1801.  https://doi.org/10.1007/s00701-017-3274-1 CrossRefGoogle Scholar
  16. 16.
    Meyer C, Bredow J, Heising E, Eysel P, Müller LP, Stein G (2017) Rheumatoid arthritis affecting the upper cervical spine: biomechanical assessment of the stabilizing ligaments. Biomed Res Int 2017:6131703.  https://doi.org/10.1155/2017/6131703 Google Scholar
  17. 17.
    Akobo S, Rizk E, Loukas M, Chapman JR, Oskouian RJ, Tubbs RS (2015) The odontoid process: a comprehensive review of its anatomy, embryology, and variations. Childs Nerv Syst 31:2025–2034.  https://doi.org/10.1007/s00381-015-2866-4 CrossRefGoogle Scholar
  18. 18.
    O’Brien WT, Shen P, Lee P (2015) The dens: normal development, developmental variants and anomalies, and traumatic injuries. J Clin Imaging Sci 5:38.  https://doi.org/10.4103/2156-7514.159565 CrossRefGoogle Scholar
  19. 19.
    Baumgart M, Wiśniewski M, Grzonkowska M, Małkowski B, Badura M, Dąbrowska M, Szpinda M (2016) Digital image analysis of ossification centers in the axial dens and body in the human fetus. Surg Radiol Anat 38:1195–1203.  https://doi.org/10.1007/s00276-016-1679-9 CrossRefGoogle Scholar
  20. 20.
    Henderson P, Desai IP, Pettit K, Benke S, Brouha SS, Romine LE, Beeker K, Chuang NA, Yaszay B, van Houten L, Pretorius DH (2016) Evaluation of fetal first and second cervical vertebrae: normal or abnormal. J Ultrasound Med 35:527–536.  https://doi.org/10.7863/ultra.14.12044 CrossRefGoogle Scholar
  21. 21.
    Deng XW, Min ZH, Lin B, Zhang FH (2010) Anatomic and radiological study on posterior pedicle screw fixation in the atlantoaxial vertebrae of children. Chin J Traumatol 13:229–233Google Scholar
  22. 22.
    Cattrysse E, Provyn S, Kool P, Clarys JP, Van Roy P (2011) Morphology and kinematics of the atlanto-axial joints and their interaction during manual cervical rotation mobilization. Man Ther 16:481–486.  https://doi.org/10.1016/j.math.2011.03.002 CrossRefGoogle Scholar
  23. 23.
    Salem W, Lenders C, Mathieu J, Hermanus N, Klein P (2013) In vivo three-dimensional kinematics of the cervical spine during maximal axial rotation. Man Ther 18:339–344.  https://doi.org/10.1016/j.math.2012.12.002 CrossRefGoogle Scholar
  24. 24.
    Cattrysse E, Provyn S, Kool P, Gagey O, Clarys JP, Van Roy P (2009) Reproducibility of kinematic motion coupling parameters during manual upper cervical axial rotation mobilization: a 3-dimensional in vitro study of the atlanto-axial joint. J Electromyogr Kinesiol 19:93–104.  https://doi.org/10.1016/j.jelekin.2007.06.019 CrossRefGoogle Scholar
  25. 25.
    Cattrysse E, Baeyens JP, Kool P, Clarys JP, Van Roy P (2008) Does manual mobilization influence motion coupling patterns in the atlanto-axial joint. J Electromyogr Kinesiol 18:838–848.  https://doi.org/10.1016/j.jelekin.2007.02.015 CrossRefGoogle Scholar
  26. 26.
    Panjabi MM, Oda T, Crisco JJ 3rd, Dvorak J, Grob D (1993) Posture affects motion coupling patterns of the upper cervical spine. J Orthop Res 11:525–536.  https://doi.org/10.1002/jor.1100110407 CrossRefGoogle Scholar

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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