Morphometric Assessment of Third and Fourth Cervical Vertebra Based on Hassel and Farman Method: A Radiographic Study

Abstract

To assess third and fourth cervical vertebra morphologic dimensions as per the cervical vertebral maturation stage proposed by Hassel and Farman from 7 to 18 years. A cross-sectional radiographic study was conducted on 264 participants within an age-group of 7-18 years who were further categorized into six subgroups having an interval of 1 year and 11 months chronologic age. The maturation stage and morphometric evaluation of the cervical vertebra were assessed for the same patient. The maturation stage was assessed as per the morphologic classification given by Hassel and Farman. The morphometric evaluation was assessed by measuring the anterior (AH3 and AH4), vertebral body (H3 and H4), posterior heights, and anteroposterior width (APW3 and APW4) of third and fourth cervical vertebra in millimeters which was carried out with the help of "IC measure software." One-way analysis of variance (ANOVA), Tukey's multiple comparison, and Spearman's correlation coefficient were utilized to determine the significance and correlation between the vertebral maturation and millimetric measurement between age-groups. The multiple comparison levels were set at 0.05 level of significance. A high significant correlation was observed between PH3 and APW3 (r, 0.737**). Moderate significant correlation was observed with H3 and PH3 (r, 0.605**, 0.640*), and APW3, APW4 (r, 0.534**, 0.614*) in the initiation stage in both the vertebrae; AH3, H3 (r, 0.498**) and H3, APW3 (r, 0.576**) in deceleration stage. A negative moderate significant correlation between AH4, PH4 (r, -0.691**) was observed in the deceleration stage. The transition, maturation, and completion stages did not reveal any significant correlation. Significant morphologic difference was observed among all the stages of vertebral maturation. Higher dimensions were observed among males. Anteroposterior width had the highest dimension. Significant morphometric changes were observed in stages of maturation and transition stages. The dimensions of anterior, vertebral, and posterior height of the third and fourth cervical vertebra can supplement in identifying the precise morphologic classification whenever there is an overlap in the opinion of staging cervical vertebral maturation based on Hassel and Farman.