Morphometric analysis of the developing pediatric cervical spine

Johnson, Kyle T; Al-Holou, Wajd N.; Anderson, Richard C. E.; Wilson, Thomas J.; Karnati, Tejas; Ibrahim, Mohannad; Garton, Hugh; Maher, Cormac O.

doi:10.3171/2016.3.peds1612

Cited by 30 publications

(24 citation statements)

References 32 publications

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“…However, the present study showed continued growth in age cohort IV (15–20 years), supporting the findings that growth in size continues for well over 9 years (Johnson et al. ).…”

Section: Discussionsupporting

confidence: 91%

“…; Johnson et al. ); poor improvement over use of chronological age (Chatzigianni & Halazonetis, ), and not accounting for sexual dimorphism of the cervical spine (Caldas et al. ).…”

Section: Introductionmentioning

confidence: 99%

“…; Johnson et al. ); and quantifying the emergence of sexual dimorphism by using landmark‐based measurements to assess vertebral body geometry (Hellsing, ). Such quantitative analyses contribute to our understanding of developmental trends of growth in size and shape of cervical vertebrae.…”

Section: Introductionmentioning

confidence: 99%

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Cervical vertebral body growth and emergence of sexual dimorphism: a developmental study using computed tomography

et al. 2019

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The size and shape of human cervical vertebral bodies serve as a reference for measurement or treatment planning in multiple disciplines. It is therefore necessary to understand thoroughly the developmental changes in the cervical vertebrae in relation to the changing biomechanical demands on the neck during the first two decades of life. To delineate sex‐specific changes in human cervical vertebral bodies, 23 landmarks were placed in the midsagittal plane to define the boundaries of C2 to C7 in 123 (73 M; 50 F) computed tomography scans from individuals, ages 6 months to 19 years. Size was calculated as the geometric area, from which sex‐specific growth trend, rate, and type for each vertebral body were determined, as well as length measures of local deformation‐based morphometry vectors from the centroid to each landmark. Additionally, for each of the four pubertal‐staged age cohorts, sex‐specific vertebral body wireframes were superimposed using generalized Procrustes analysis to determine sex‐specific changes in form (size and shape) and shape alone. Our findings reveal that C2 was unique in achieving more of its adult size by 5 years, particularly in females. In contrast, C3–C7 had a second period of accelerated growth during puberty. The vertebrae of males and females were significantly different in size, particularly after puberty, when males had larger cervical vertebral bodies. Male growth outpaced female growth around age 10 years and persisted until around age 19–20 years, whereas females completed growth earlier, around age 17–18 years. The greatest shape differences between males and females occurred during puberty. Both sexes had similar growth in the superoinferior height, but males also displayed more growth in anteroposterior depth. Such prominent sex differences in size, shape, and form are likely the result of differences in growth rate and growth duration. Female vertebrae are thus not simply smaller versions of the male vertebrae. Additional research is needed to further quantify growth and help improve age‐ and sex‐specific guidance in clinical practice.

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“…However, the present study showed continued growth in age cohort IV (15–20 years), supporting the findings that growth in size continues for well over 9 years (Johnson et al. ).…”

Section: Discussionsupporting

confidence: 91%

“…; Johnson et al. ); poor improvement over use of chronological age (Chatzigianni & Halazonetis, ), and not accounting for sexual dimorphism of the cervical spine (Caldas et al. ).…”

Section: Introductionmentioning

confidence: 99%

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Cervical vertebral body growth and emergence of sexual dimorphism: a developmental study using computed tomography

et al. 2019

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“…20 However, a morphometric study reported that the normal vertical growth of the pediatric C-spine continues up to 18 years of age in boys. 21 In the present case, 6 months after removing the cervical plate, the lateral X-rays demonstrated an improvement of the cervical curvature ( Figure 4; Table 1). In addition, there were no further clinical complaints.…”

Section: Discussionsupporting

confidence: 55%

Anterior cervical corpectomy and fusion in a 7-year-old boy: a case report

Saekhu¹,

Ashari²,

Tandian³

et al. 2019

Med J Indones

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Bicycle mishap, a common and ordinary event occurring in children, can have devastating consequences associated with cervical spine injury. Furthermore, either diagnosis or surgical management of cervical spine injury in children is a challenging issue. This research report a challenging case of an anterior cervical corpectomy and fusion with plating in a 7-year-old boy due to cervical spine instability with spinal cord compression after a bicycle mishap. After 20 months of the primary surgery, the titanium-based cervical plate was removed by a second surgery to allow the growth of the cervical spine.

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“…A major difference between the pediatric spine and adult spine is the potential for continued growth from childhood to adolescence. 71 This growth must be factored into any decision of performing a long-segment fusion in a child. Adverse iatrogenic effects from spinal fusion include limitation of range of motion, stunting future growth, development of secondary deformity (e.g., crankshaft deformity), and adjacent-level disease.…”

Section: Long-term Consequences Of Fusion In a Growing Spinementioning

confidence: 99%

Spinal instrumentation in infants, children, and adolescents: a review

Mendenhall

Mobasser

Relyea

et al. 2019

Journal of Neurosurgery: Pediatrics

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OBJECTIVEThe evolution of pediatric spinal instrumentation has progressed in the last 70 years since the popularization of the Harrington rod showing the feasibility of placing spinal instrumentation into the pediatric spine. Although lacking in pediatric-specific spinal instrumentation, when possible, adult instrumentation techniques and tools have been adapted for the pediatric spine. A new generation of pediatric neurosurgeons with interest in complex spine disorder has pushed the field forward, while keeping the special nuances of the growing immature spine in mind. The authors sought to review their own experience with various types of spinal instrumentation in the pediatric spine and document the state of the art for pediatric spine surgery.METHODSThe authors retrospectively reviewed patients in their practice who underwent complex spine surgery. Patient demographics, operative data, and perioperative complications were recorded. At the same time, the authors surveyed the literature for spinal instrumentation techniques that have been utilized in the pediatric spine. The authors chronicle the past and present of pediatric spinal instrumentation, and speculate about its future.RESULTSThe medical records of the first 361 patients who underwent 384 procedures involving spinal instrumentation from July 1, 2007, to May 31, 2018, were analyzed. The mean age at surgery was 12 years and 6 months (range 3 months to 21 years and 4 months). The types of spinal instrumentation utilized included occipital screws (94 cases); C1 lateral mass screws (115 cases); C2 pars/translaminar screws (143 cases); subaxial cervical lateral mass screws (95 cases); thoracic and lumbar spine traditional-trajectory and cortical-trajectory pedicle screws (234 cases); thoracic and lumbar sublaminar, subtransverse, and subcostal polyester bands (65 cases); S1 pedicle screws (103 cases); and S2 alar-iliac/iliac screws (56 cases). Complications related to spinal instrumentation included hardware-related skin breakdown (1.8%), infection (1.8%), proximal junctional kyphosis (1.0%), pseudarthroses (1.0%), screw malpositioning (0.5%), CSF leak (0.5%), hardware failure (0.5%), graft migration (0.3%), nerve root injury (0.3%), and vertebral artery injury (0.3%).CONCLUSIONSPediatric neurosurgeons with an interest in complex spine disorders in children should develop a comprehensive armamentarium of safe techniques for placing rigid and nonrigid spinal instrumentation even in the smallest of children, with low complication rates. The authors’ review provides some benchmarks and outcomes for comparison, and furnishes a historical perspective of the past and future of pediatric spine surgery.

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Morphometric analysis of the developing pediatric cervical spine

Cited by 30 publications

References 32 publications

Cervical vertebral body growth and emergence of sexual dimorphism: a developmental study using computed tomography

Cervical vertebral body growth and emergence of sexual dimorphism: a developmental study using computed tomography

Anterior cervical corpectomy and fusion in a 7-year-old boy: a case report

Spinal instrumentation in infants, children, and adolescents: a review

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