Pediatric Lateral Atlantodental Interval

Abstract

Imaging of the cervical spine is commonly performed in the pediatric patient population, typically after trauma, as well as for a variety of nontraumatic reasons. There are many challenges in the interpretation of these studies, particularly at the level of the atlantoaxial joint. We recognized a particular problem with assessing the lateral atlantodental interval in our emergency radiology department. Mild lateral atlantodental interval asymmetry in relatively asymptomatic patients was being interpreted as indicative of atlantoaxial rotatory fixation, which leads to the recommendation for dynamic computed tomographic examinations. The goal of this study was to define the reference range of the lateral atlantodental interval in pediatric patients to help avoid misinterpretation of radiographic findings and resultant excessive imaging.

Asymmetry of the Odontoid Lateral Mass Interval in Pediatric Trauma CT: Do We Need to Investigate Further?

“…The mean OLMI asymmetry in the noninjured patients was 1.4 Ϯ 0.7 mm, which is similar to results obtained in prior studies in children, 10 therefore confirming the validity of our data. The asymmetry in the injured group was 3.8 Ϯ 2.2 mm, which overlaps with the noninjured group.…”

“…Accumulating data show that OLMI asymmetry can be a normal variant in adults 6-9,11,12 and children, 10 or it can be related to head positioning. Nevertheless, OLMI asymmetry can also imply ligamentous cervical spine injury at the craniocervical junction, which can be considerably disabling and even lethal.…”

“…[6][7][8][9][10][11][12] It is thought to arise from anatomic variation, head rotation, and muscle spasm. Nevertheless OLMI asymmetry might also imply ligamentous injury or atlantoaxial rotational fixation/subluxation at the C1-C2 level which, if present, could potentially lead to a catastrophic sequela.…”

Evaluation of lateral atlantodental interval asymmetry in the pediatric age group: normative values

“…The overall mean for LADI asymmetry was 0.09 ± 1.23 mm (range -6.05 to 4.87 mm). Our results are consistent with those of CT-based LADI asymmetry reported by Borders et al 3 and Eran et al 9 (1.38 ± 1.26 mm and 1.4 ± 0.7 mm, respectively), confirming the validity of our data.…”

“…The dilemma concerning whether additional workup is needed for a child with LADI asymmetry is encountered frequently in busy emergency departments and trauma centers. 9 Mounting evidence seems to suggest that LADI asymmetry can be a normal variant in adults 2,5, 9, 11-13, 17,24 and children, 3,9 or it can be related to head positioning. 9 On the contrary, asymmetry of LADI can also suggest ligamentous cervical spine injury, which, if left undiagnosed or untreated, may lead to severe and catastrophic consequences.…”