Aims of the Study: Trauma is common in pediatrics. Although cases of neck injury are relatively rare, can be critical. The use of CT imaging in children is always expanding, due to the development of technological advances allowing lower radiation exposure. In the medical literature regarding CT examinations in the pediatric population, accurate measurements of the normal relationships between the upper cervical vertebrae and between them and the skull base have not been established. The aim of our study is to develop a systematic method of evaluation of such measurements, which may contribute to the early diagnosis and treatment of cervical spine injury.
Methods: A retrospective evaluation of 300 CT examinations was performed. They contained scans of the upper cervical spine in children aged 0-16 years which were divided into 3 groups: babies (0-3 years), children (4-10 years) and adolescents (11-16 years), all of which had been interpreted as normal. All the examinations were performed in Kaplan Medical Center between 01/01/10 and 31/12/14.
Measurements of several variables were performed: the distance between skull base and C1 vertebra and the distance between the C1 and C2 vertebrae. “Key Images” were created within the PACS (Picture Archiving and Communication System) for each examination by a senior radiologist according to protocol specifications in order to maintain uniformity. They included one image in a midsagittal reformation and two images in a coronal reformation. On these “Key Images”, measurements as mentioned above were performed separately by two radiologists: a resident radiologist and a senior radiologist.
Results: The measurements in the midsagittal plane showed variability and high standard deviations in comparison with the measurements in the coronal plane. Therefore, the measurements in the midsagittal plane could not serve as a reliable measurement. On the other hand, the measurements in the coronal plane were found to be symmetrical in all age groups. There was however, statistical agreement between the radiologists only for the measurement at C1-C2 level and not for skull base- C1 level. Therefore, we only regard to the measurements performed at C1-C2 level.
Conclusions: In babies, the upper limit of the normal distance between C1 and C2 vertebrae in the coronal place is 1.96 mm and in children the value is 1.95 mm. In adolescents, the upper limit of normal of this distance is 1.58 mm. A larger distance would be outside a range of 95% and therefore would be suspicious for cervical spine injury.
