Atlantoaxial interlaminar distances in cervical flexion in children

View More View Less
  • 1 Department of Cell Biology, University of Alabama at Birmingham; and Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object. To the best of the authors' knowledge, no quantitative analysis of the atlantoaxial interlaminar distance in flexion (ILD) in children exists in the medical literature. In this study they sought to determine the age-matched relationship between the posterior elements of the atlas and axis in children in cervical spine flexion, to be used as an adjunct to the atlantodental interval in common clinical use.

Methods. Lateral radiographs of the cervical spine in full flexion were analyzed in 74 children. The atlantoaxial ILD was defined as the distance between a midpoint of the anterior cortices of the atlantal and axial posterior arches.

The mean ILD for the entire group was 19 mm (range 8–30 mm). No significant difference was seen between male and female patients (p = 0.084). When stratified by age, the mean ILD was 12.3 ± 3 mm (15 cases) in children age 3 years or younger and 20.5 ± 4.7 mm (59 cases) in children age older than 3 years. Further stratification of the groups yielded a mean ILD of 10.4 ± 1.4 [eight cases]) in children age 1 to 2 years, and 14.4 ± 4.7 mm (seven cases) in children age 3 years. In children older than 3 years of age the mean ILD was consistently approximately 20 ± 5 mm regardless of age.

Conclusions. Rapid, safe, and accurate diagnosis of the cervical spine is essential in critical care. Knowledge of the distance between the posterior elements of the atlas and axis in flexion should enhance the clinicians' (those who clear cervical spines) ability to diagnose accurately atlantoaxial instability on lateral radiographs obtained in flexion.

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: R. Shane Tubbs, Ph.D., Pediatric Neurosurgery, 1600 7th Avenue South Acc 400, Birmingham, Alabama 35233. email: richard.tubbs@ccc.uab.edu.
  • 1.

    Cattell HS, & Filtzer DL: Pseudosubluxation and other normal variations in the cervical spine in children. A study of one hundred and sixty children. J Bone Joint Surg Am 47:12951309, 1965 Cattell HS, Filtzer DL: Pseudosubluxation and other normal variations in the cervical spine in children. A study of one hundred and sixty children. J Bone Joint Surg Am 47:1295–1309, 1965

    • Search Google Scholar
    • Export Citation
  • 2.

    Duncan JM: Laboratory note: on the tensile strength of the fresh adult foetus. Br Med J 2:763, 1874 Duncan JM: Laboratory note: on the tensile strength of the fresh adult foetus. Br Med J 2:763, 1874

    • Search Google Scholar
    • Export Citation
  • 3.

    Grantham SA: Rheumatoid arthritis and other noninfectious inflammatory diseases: atlantoaxial instability in Bailey RW, , Sherk HH, & Dunn EJ, et al (eds): The Cervical Spine. Philadelphia: JB Lippincott, 1983, pp 356387 Grantham SA: Rheumatoid arthritis and other noninfectious inflammatory diseases: atlantoaxial instability in Bailey RW, Sherk HH, Dunn EJ, et al (eds): The Cervical Spine. Philadelphia: JB Lippincott, 1983, pp 356–387

    • Search Google Scholar
    • Export Citation
  • 4.

    Hensinger RN: Osseous anomalies of the craniovertebral junction. Spine 11:323333, 1986 Hensinger RN: Osseous anomalies of the craniovertebral junction. Spine 11:323–333, 1986

    • Search Google Scholar
    • Export Citation
  • 5.

    Locke GR, , Gardner JI, & Van Epps EF: Atlas-dens interval (ADI) in children: a survey based on 200 normal cervical spines. Am J Roentgenol Radium Ther Nucl Med 97:135140, 1966 Locke GR, Gardner JI, Van Epps EF: Atlas-dens interval (ADI) in children: a survey based on 200 normal cervical spines. Am J Roentgenol Radium Ther Nucl Med 97:135–140, 1966

    • Search Google Scholar
    • Export Citation
  • 6.

    Lovelock JE, & Schuster JA: The normal posterior atlantoaxial relationship. Skeletal Radiol 20:121123, 1991 Lovelock JE, Schuster JA: The normal posterior atlantoaxial relationship. Skeletal Radiol 20:121–123, 1991

    • Search Google Scholar
    • Export Citation
  • 7.

    Martinez-Lozano AG: Radiographic measurements, in Weinstein SL (ed): The Pediatric Spine Principles and Practice, ed 2. Philadelphia: Lippincott Williams & Wilkins, 2001, pp 965999 Martinez-Lozano AG: Radiographic measurements, in Weinstein SL (ed): The Pediatric Spine Principles and Practice, ed 2. Philadelphia: Lippincott Williams & Wilkins, 2001, pp 965–999

    • Search Google Scholar
    • Export Citation
  • 8.

    McGrory BJ, , Klassen RA, & Chao EYS, et al: Acute fractures and dislocations of the cervical spine in children and adolescents. J Bone Joint Surg Am 75:988995, 1993 McGrory BJ, Klassen RA, Chao EYS, et al: Acute fractures and dislocations of the cervical spine in children and adolescents. J Bone Joint Surg Am 75:988–995, 1993

    • Search Google Scholar
    • Export Citation
  • 9.

    Naidich JB, , Naidich TP, & Garfein C, et al: The widened interspinous distance: a useful sign of anterior cervical dislocation in the supine frontal projection. Radiology 123: 113116, 1977 Naidich JB, Naidich TP, Garfein C, et al: The widened interspinous distance: a useful sign of anterior cervical dislocation in the supine frontal projection. Radiology 123: 113–116, 1977

    • Search Google Scholar
    • Export Citation
  • 10.

    Suss RA: Cervical spine, in Redman HC, , Miller GL, & Purdy PD, et al (eds): Emergency Radiology. Philadelphia: WB Saunders, 1996, pp 179217 Suss RA: Cervical spine, in Redman HC, Miller GL, Purdy PD, et al (eds): Emergency Radiology. Philadelphia: WB Saunders, 1996, pp 179–217

    • Search Google Scholar
    • Export Citation
  • 11.

    Swischuk LE: Anterior displacement of C2 in children: physiologic or pathologic. Radiology 122:759763, 1977 Swischuk LE: Anterior displacement of C2 in children: physiologic or pathologic. Radiology 122:759–763, 1977

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 199 111 14
Full Text Views 40 4 1
PDF Downloads 114 0 0
EPUB Downloads 0 0 0