The Normal Cervical Spine in Infants and Children

Abstract

numerous papers on the subject of roentgenology of the cervical spine, especially with reference to the roentgen anatomy, have been published. Most of these deal exclusively with adults. The material presented here, although not new, represents an attempt to bring together data concerning the cervical spine in infants and children. In this age group, the developmental anatomy of the cervical spine must be correlated with the roentgen appearance. Because the appreciation and appraisal of roentgen abnormalities depend so much on a thorough understanding of the normal, the normal will be discussed and only a few pertinent anomalies will be mentioned. The present study is based in part on roentgenograms of the cervical spine in approximately 100 normal children ranging from the newborn infant to the age of fourteen years. None of these children had a known history of trauma. The technics employed to obtain satisfactory films of the cervical spine are not pertinent to the discussion, but certain difficulties arise in the examination of children which are not encountered in adults. These are attributable to lack of cooperation and the immature state of muscular development in infants. It is often impossible to obtain upright films, laminagrams, and stereoscopic examinations. Sedation is frequently necessary to obtain even routine recumbent films. As a result, not all of the modalities used in studying adults are available for children. The normal appearance in the few standard projections must therefore be stressed. The anatomical details are best demonstrated by means of reproductions of drawings and roentgenograms. The illustrations are of three types: (1) those which show the developmental anatomy of the cervical vertebrae (Figs. 1–3); (2) representative roentgenograms of the normal cervical spines of infants and children (Figs. 4–15); (3) a diagram for orientation in oblique spine projections (Fig. 16). No roentgenograms of children over eight years of age are included because, with few exceptions, the cervical spine has attained an adult form by this age. First Cervical Vertebra (Atlas): Among other features, cervical vertebrae differ from the dorsal and lumbar vertebrae in that they have a foramen in each transverse process. The first and second cervical vertebrae also differ from the other cervical vertebrae because of certain distinguishing characteristics. The first cervical vertebra is normally formed from three primary ossification centers, one for each neural arch and one for the body. There are three principal variations in development. (1) The bodies may arise from two centers, which ultimately fuse with each other and with the neural arches. (2) Occasionally an ossification center for the body fails to appear and in its place there are forward extension and fusion of the anterior portions of each neural arch. (3) The center for the body may be absent and the lateral masses fail to fuse anteriorly, resulting in a cleft.