In vitro characterization of the anterior to posterior curvature of the superior articular facets of the atlas as a function of age

Abstract

Background context Reference is made in the literature to the inherent instability of the atlantooccipital joint in infants and young children because of pliant ligaments, undeveloped musculature, smaller condyles, and the relative lack of anteroposterior curvature of the superior articular facet surfaces of the atlas. The combination of these morphologic factors is purported to make this population particularly vulnerable to whiplash-type injuries. Although a significant difference in the magnitude of the anteroposterior curvature of the superior articular facet surfaces of the atlas between young children and adults has been observed, quantitative analysis of the curvature of these surfaces has not been documented. Purpose To quantify the anterior to posterior curvature of the superior articular facet surfaces of the atlas as a function of age. Study design This study is a retrospective analysis of the anterior to posterior curvature of the superior articular facet surfaces of the atlas as a function of age in 15 pediatric cadaver specimens from the Hamann-Todd Osteology Collection in Cleveland, Ohio, and 18 adult cadaver specimens from the Department of Experimental Anatomy in Brussels, Belgium. Methods A stylus, connected to a three-dimensional digitizer, was used to manually define a series of points on the perimeter of the superior articular facet surfaces of the atlas of each specimen. The digitized data points were then used to generate two planes that approximated the anterior and posterior aspects of the articular surfaces in three-dimensional space. A line through a point on each plane and perpendicular to that plane was defined for each of the two planes. The angle between the two perpendicular lines was calculated and used to quantify the curvature of the facet surface. Results The anteroposterior curvature of the superior articular facet surfaces of the atlas increases from an average angle of 11.5 (±4.7) degrees at 1 year of age and asymptotically approaches an average angle of 43.5 (±13.4) degrees at 80 years of age. There is a direct relationship between age and the anterior to posterior curvature of the superior articular surfaces of the atlas that can be approximated (r 2=0.94) with a sigmoid function. Ninety percent of the final curvature is achieved at approximately 8 years of age.