Vertebrae In Children Research Articles

Lumbosacral transitional vertebrae in children and adolescents (literature review, illustrated with clinical observations)

Introduction An analysis of the medical literature devoted to various aspects of transitional lumbosacral vertebrae shows that there are very few publications covering the course of this disease in the pediatric and adolescent population.Aim To study the issues of epidemiology, diagnosis, treatment and prevention of transitional lumbosacral vertebrae in paediatric and adolescent patients based on the analysis of current medical literature and illustrate the material with our own clinical observations.Material and methods To analyze the literature on the topic, 75 papers published between 1984 and 2023 were selected. Among them, there were 7 (9.3 %) domestic literary sources, 68 (90.7 %) were foreign. In the process of searching for scientific articles, the resources of the electronic databases of current medical information PubMed and CyberLeninka were used.Results and discussion The incidence of transitional vertebrae in children and adolescents is 16.8 % of clinical observations, as reported. In the structure of the transitional vertebrae in children, type II of the disease predominates according to the classification Castellvi et al (1984), 43.2 % of cases. The main clinical symptom of the pathology is pain of lumbosacral location, the intensity of which on the visual analog scale in children corresponds to an average of 3.0 points. In adult patients with similar pathology, the average pain intensity measured with the same scale is 7.5 points. The most informative method for diagnosing the disease is computed tomography, which allows obtaining both 3D images and sections at the level of pseudarthrosis between the enlarged transverse process (or processes) of the suprasacral vertebra and the wing of the sacrum. To relieve pain in children with transitional vertebrae, both conservative and surgical methods are used. The most commonly used procedure is pseudarthrectomy. The study of long-term results one year after the intervention allowed us to record the absence of pain in children who underwent surgery. Prevention measures for transitional lumbosacral vertebrae have not been developed.Conclusion The analysis of the published literature shows that transitional vertebrae are a frequently diagnosed pathology in children and adolescents. Current methods of imaging are able to accurately detect not only the presence of the disease, but also to differentiate its type. The main clinical symptom of transitional vertebrae is pain in the lumbosacral spine which is difficult to relieve with conservative therapy. Pseudarthrectomy is the most frequent surgical method of treatment in children and adolescents that provides stable relief of vertebrogenic pain syndrome. Measures for specific prevention of the disease have not been developed.

Giant Hydronephrosis Mimicking an Intraabdominal Mass: Case Report

Giant hydronephrosis (GH) is a rare entity that may mimic progressive and benign abdominal cystic tumor, is defined as a collection of more than 1 litre of urine in the excretory cavities or as a dilation beyond the mid-abdominal line with a kidney length exceeding 5 vertebrae in children. It is rare, often due to a pyelo ureteral junction syndrome. The antenatal ultrasound must make the diagnosis before birth. We report the case of an 2-month-old infant, brought to the consultation for progressive abdominal distension since birth but aggravated since 1 month. The physical examination had revealed an abdominal mass occupying the whole abdomen, but more marked on the right, taut and matt to the percussion and whose limits and origin were difficult to determine. The abdominopelvic ultrasound had shown an echo-fluid structure mass extending from the right hypochondrium to the pelvis and well beyond the midline. The urotomodensitometry (uro-TDM) had shown at right giant hydronephrosis in the form of a voluminous liquid mass extending from the subhepatic region into the pelvis beyond the midline. This mass was surrounded by a thin parenchymal border with an elevation corresponding to the renal parenchyma.

Переходные пояснично-крестцовые позвонки у детей и подростков с травмой люмбального отдела позвоночника: частота диагностики и особенности клинической симптоматики

There is a paucity of Russian medical literature reporting lumbosacral transitional vertebrae in children and adolescents. Many important aspects of the condition including two nosologies of sacralization of the L5 vertebrae and lumbalization of the S1 vertebrae have been under-explored. The objective was to establish overall frequency and frequency of certain types of lumbosacral transitional vertebrae in children and adolescents who sustained a lumbar injury and to investigate clinical manifestations of the pathology. Material and methods A comprehensive examination of 312children aged 7 to 18 years who suffered a lumbar injury was performed. Lumbosacral transitional vertebrae was radiologically diagnosed in 19 (6.09 %) subjects. Grading system of A.E. Castellvi et al. (1984) was used to classify the pathology. Results From 19 patients with lumbosacral transitional vertebrae, sacralization of the L5 vertebrae was detected in 16 (84.21 %) individuals. Lumbalization of the S1 vertebrae was diagnosed in 3 (15.79 %) children. Type II (n = 13) and subtype "b" (n = 10) were most common. No types III and IV of the disease were seen. No clinical symptoms indicating the likelihood of having lumbosacral transitional vertebrae were observed in the patients prior to the lumbar injury. Conclusion The frequency of occurrence of lumbosacral transitional vertebrae and its structure were reviewed in children and adolescents. The patients demonstrated no clinical manifestations of the condition before the children sustained lumbar injuries. Various aspects of transitional lumbar vertebrae in children and adolescents require further study.

First description of frequent occurrence of supernumerary lumbar ribs and transitional vertebrae in children with Williams-Beuren syndrome.

Williams-Beuren syndrome is a rare multisystemic genetic disorder with an incidence of 1 in 7,500 live births. Because these children often have scoliosis, they undergo routine radiographic examinations of the spine. During these examinations we have found many children with supernumerary lumbar ribs arising from the first lumbar vertebra, often associated with lumbosacral transitional vertebrae. To describe the incidence of supernumerary ribs and transitional vertebrae in children with Williams-Beuren syndrome and compare it to the incidence in a general population. Our hypothesis is that these findings are common, but they have not been described in the literature concerning Williams-Beuren syndrome. From January 2015 to October 2021, 308 patients (138 male) with Williams-Beuren syndrome were treated at our hospital. Of these, 106 (47 male) underwent diagnostic imaging, mostly for suspected scoliosis. Panoramic radiographs of the whole spine were performed in 88 patients and radiographs of regions of the spine, chest radiographs, CT, MRI or fluoroscopy in 18 patients. We retrospectively analysed the images concerning the number of ribs and vertebrae. We correlated the frequency of lumbar ribs and transitional vertebrae in comparison to a general population as described in the literature. After exclusions for insufficient imaging, we analysed imaging in 91 patients. Of these, 67 patients (73.6%) had 13 ribs, of which 85% were located on both sides, 9% on the right and 6% on the left side. Of the 67 patients with supernumerary lumbar ribs, 38 (57%) also had transitional vertebrae. Supernumerary lumbar ribs arising from the first lumbar vertebra, often accompanied by lumbosacral transitional vertebrae, are common in children with Williams-Beuren syndrome.

Transpharyngeal closed reduction displacement of the first cervical vertebra in children

BACKGROUND: Currently, the treatment of children with atlantoaxial rotational block has no standard protocol. The proposed conservative methods are difficult and require long-term hospitalization, whereas surgical treatment is associated with a risk of complications.
 AIM: This study aimed to develop and evaluate the effectiveness of the transpharyngeal closed reduction method for first cervical vertebral displacement in children.
 MATERIALS AND METHODS: The study presents the analysis results of clinical cases of 46 children with atlantoaxial rotational fixation with types III subluxations by Fielding and Hawkins the CI transpharyngeal closed reduction method. The average age of the patients was 4.5 2.6 years. The time of admission of patients after the disease onset varied from 1 to 30 days. The reduction technique consisted of the following elements: 1. A bracket is installed for traction behind the skull along the axis; 2. The surgeon pulls the bracket along the axis, while using the index finger of the other hand in the oropharynx fixes the anterior arch of the atlas, creating a fulcrum; 3. Rotational displacement of the atlas is eliminated by rotational movements with simultaneous traction along the axis; and 4. The anatomical position of the atlas and axis is controlled by an X-ray image intensifier.
 RESULTS: Only in one case of recurrent dislocation was noted after 4 days. The efficiency of primary reduction was 97.8%. Pain syndrome on the visual analog scale was reduced by 62.3%. Neurological deficit recurrence was not noted. The average bed-day was 2.5 1.3 days.
 CONCLUSION: Transpharyngeal closed reduction method for first cervical vertebral displacement in children of the younger age group is effective for atlantoaxial rotational fixation treatment in early admitted patients, which determines the prospects for its wider application in the practice of specialized hospitals.

Enchondromatosis with cervical spine involvement in children: small series and review

Objective: to present different variants of the clinical course and surgical treatment of an extremely rare vertebral pathology – enchondromatosis with involvement of the cervical vertebrae in children. Two cases of local and multiple forms of bone dyschondroplasia with damage to the cervical vertebrae, accompanied by orthopedic and neurological complications in children aged 7 and 11, are described. As a result of the operation, complaints were completely stopped in one child and neurological disorders were eliminated in another. The diagnosis was verified histologically. The results were followed up for more than 2 years and 1 year after the operation, respectively. Present-day data on Ollie’s disease in children are presented. Indications, timing and volume of surgical intervention for bone dyschondroplasia are determined individually, depending on the size, location, and number of enchondromas. However, if the cervical spine involvement is complicated by increasing pain and neurological disorders, it is precisely decompression of the spinal cord that should be set as a priority aim of the surgery.

Неосложненные переломы шейных позвонков у детей и подростков

Introduction Various aspects of uncomplicated fractures of the cervical vertebrae in children and adolescents remain topical. Purpose To study incidence, character and type of uncomplicated fractures of the vertebrae of the cervical spine in children and adolescents. Materials and methods Out of 1000 children who had uncomplicated vertebral fractures, 27 (2.7 %) people were diagnosed with fractures at the cervical level. There were more boys among the injured – 77.77 % of the injured. 29.63 % of the patients were under the age of 12, and 70.37 % of – aged 12–17. Traditional methods for emergency traumatology were used for clinical diagnostics. Results In 17 (62.96 %) of the patients only the cervical vertebrae were compressed, in 10 (37.04 %) patients – both the thoracic vertebrae and the cervical vertebrae. Among the cervical vertebrae, compression of C7 vertebral body was most often observed – in 30.64 % of cases, less often – the body of C3 – in 4.08 % of cases. The main mechanism of injury was falling on head from a height of 2 m and more – 25.98 % of cases. Analysis of the character of C2 fractures showed that four patients had fractures of the odontoid process (three patients – type I, one – type III), one patient – fractures of the arches of this vertebra corresponding to type I. Fractures of subaxial location mainly corresponded to group "A" (subgroup I (36 compressed vertebrae), subgroup II (6 injured vertebrae)). In 2 cases, vertebral fractures were referred to group "B" (subgroup I). In 25 (92.59 %) clinical cases conservative treatment was used, in 2 (7.41 %) – there were indications for surgical treatment. The average duration of in-patient treatment for fractures of the cervical vertebrae was 9.4 days. Evaluation of long-term treatment results showed "good" results in 83.33 % of cases, satisfactory – in 16.67 % of clinical observations. Discussion The results that we have received are mainly comparable with the literature data on the main aspects of cervical trauma in children. At the same time, it is necessary to mention some differences. For example, many authors report that younger children most often get fractures of the C2 vertebra. According to our data, the average age of patients with these fractures was 14.8 years.

Proton magnetic resonance spectroscopy as an alternative method for quantitative assessment of mineral bone density

Aims: 1) To evaluate an association between the fat fraction (FF) and bone mineral density (BMD) measured by localized proton magnetic resonance spectroscopy (1H-MRS) and quantitative computed tomography (QCT) densitometry, respectively, in healthy vertebrae of children after a compression fracture; 2) To compare the FF and BMD values with the severity of the compression vertebrae fractures.Materials and methods: Twenty (20) patients (aged 11.1±2.1 years) with a trauma-induced compression vertebral fractures participated in the study. The BMD of L3, L4 vertebrae (mg/cm3) was measured in by QCT (Philips Brilliance 16). FF in the same area was measured from 1H-MR-spectra (STEAM, echo time (TE)=12.8 ms, repetition time (TR)=3000 ms, voxel size=20×15×10 mm) using Philips Achieva TX 3.0T MRI scanner.Results: Correlation analysis revealed a significant inverse linear correlation (r=-0.55, p=0.0004) between FF and BMD of L3 и L4 vertebrae. In addition, in the patients with severe compression vertebral fracture (more than 2 fractured vertebrae) there was a significant increase in FF values and a BMD decrease, compared to the values in the patients with mild fractures (1–2 fractured vertebrae).Conclusion: The correlation suggests that the increase of FF in the bone marrow and the decrease of BMD in children go in parallel. Therefore, 1H-MRS could be an alternative to QCT and dual-energy X-ray absorptiometry. The absence of radiation load allows for recommendation to use 1Н-MRS for screening and follow-up, as well as for the control of BMD.

TOMOGRAPHIC ANALYSIS OF C7, T1 AND T2 VERTEBRAE ANATOMY IN CHILDREN.

ABSTRACTObjective: To evaluate and compare anatomical measurements of C7, T1 and T2 vertebrae in children from 3 to 12 years of age to provide useful epidemiological data for determining the safe anatomical margin for transpedicular and translaminar fixation with screws in this population.Methods: This observational retrospective cross-sectional study evaluated 76 computed tomography scans obtained over 6 months, analyzing the following parameters: the angle of attack, length, thickness and diameter of the pedicle; and the angle of attack, length and thickness of the lamina.Results: The lamina length and thickness, as well as pedicle length varied in size according to age. Although the angle of attack was similar across different ages, age-dependent variation occurred in the T1 vertebra.Conclusion: Screws with a 3.5 mm diameter are safe to use in the C7 and T2 pedicles, while the T1 pedicle allows the introduction of larger screws ranging from 3.5-4.5 mm in diameter. In the lamina, 3.5 mm screws are safe for use only in children older than 7 years. However, each case should be analyzed individually, with the present study not aiming to replace the preoperative use of CT. Level of Evidence III, Retrospective comparative study.

Anatomical and Anthropometric Features of Bone Bodies Structures in Children with Idiopathic Scoliosis of Lenke III Type

Objective. Lenke III type spinal curvature occurs in 11% of all types of deformities in idiopathic scoliosis. Knowledge of the features of the structure of the bone structures throughout the main curve of the deformity allows you to properly plan the installation of transpedicular supporting elements during the operation and carry out a specific sequence of correcting manipulations in order to achieve the optimal result.Purpose. To study the anatomical and anthropometric features of the bone structures of the vertebrae in children with idiopathic scoliosis, type lenke III, using a navigation device.Materials and Methods. The study included 23 patients with S-type idiopathic scoliosis type III according to the classification of L. Lеnke aged 14 to 18 years, of which 22 are female patients and 1 male. All children carried out spinal X-rays in standard projections (direct and lateral), multislice computed tomography, according to msct in the navigation unit measured anatomical and anthropometric indicators, certain parameters and coefficients were calculated mathematically.Results. The following patterns were determined: pronounced asymmetry of both the width and height of the bases of the arches of the vertebrae along the concave and convex sides of the deformity in the thoracic spine and moderately pronounced structural changes in the bone structures in the lumbar spine. Strong direct correlations between the asymmetry coefficient of the base areas of the arcs and the asymmetry coefficients of the width and height of the base of the arcs, as well as a direct correlation between the values of the rotational value of the apical vertebra and the asymmetry coefficient of the base areas of the arcs in the thoracic region were revealed. In the lumbar spine, only a directly proportional relationship was found between the asymmetry coefficient of the areas of the bases of the arches of the vertebrae and the coefficient of asymmetry of the heights of the bases of the arcs of the vertebrae.Conclusion. Ап analysis of the anatomical and anthropometric parameters of the bony structures of the vertebrae in children with idiopathic scoliosis of the lenke III type has made it possible to identify certain features, to establish patterns and correlations that characterize this variant of deformity.

FEATURES OF THE DIAGNOSIS OF UNCOMPLICATED COMPRESSION FRACTURE OF THE THORACIC SPINE IN CHILDREN

X-ray diagnostics of compression fractures of bodies of the thoracic vertebrae in children not seldom causes great difficulties due to the fact that even in healthy children vertebrae have a number of features, particularly, the wedge shape. For the purpose of differential diagnosis there was performed chest X-ray examination of the thoracic vertebrae in healthy children and cases after the compression damage. The wedge index and the disk coefficient for various segments of the thoracic spine were calculated. The diagnostic efficiency of radionuclide studies was estimated to reaches 79%. The useof highly informative modern medical techniques (CT and MRI) in the diagnosis of vertebral compression fractures in children allows accurately and timely make the diagnosis and determine the condition of the surrounding tissues. Based on the analysis of medical records, radiographs, identification of options of radionuclide, CT and MRI studies, there was elaborated an algorithm for the diagnosis of compression fractures of vertebrae, which allowed optimize the diagnostic process. There are determined advantages of this algorithm.

Management of vertebral radiotherapy dose in paediatric patients with cancer: consensus recommendations from the SIOPE radiotherapy working group.

Inhomogeneities in radiotherapy dose distributions covering the vertebrae in children can produce long-term spinal problems, including kyphosis, lordosis, scoliosis, and hypoplasia. In the published literature, many often interrelated variables have been reported to affect the extent of potential radiotherapy damage to the spine. Articles published in the 2D and 3D radiotherapy era instructed radiation oncologists to avoid dose inhomogeneity over growing vertebrae. However, in the present era of highly conformal radiotherapy, steep dose gradients over at-risk structures can be generated and thus less harm is caused to patients. In this report, paediatric radiation oncologists from leading centres in 11 European countries have produced recommendations on how to approach dose coverage for target volumes that are adjacent to vertebrae to minimise the risk of long-term spinal problems. Based on available information, it is advised that homogeneous vertebral radiotherapy doses should be delivered in children who have not yet finished the pubertal growth spurt. If dose fall-off within vertebrae cannot be avoided, acceptable dose gradients for different age groups are detailed here. Vertebral delineation should include all primary ossification centres and growth plates, and therefore include at least the vertebral body and arch. For partial spinal radiotherapy, the number of irradiated vertebrae should be restricted as much as achievable, particularly at the thoracic level in young children (<6 years old). There is a need for multicentre research on vertebral radiotherapy dose distributions for children, but until more valid data become available, these recommendations can provide a basis for daily practice for radiation oncologists who have patients that require vertebral radiotherapy.

Study of lesions of the lumbar endplate based on the stage of maturation of the lumbar vertebral body: the relationship between skeletal maturity and chronological age.

The lesion of the lumbar endplate is sometimes identified in the vertebrae of children and adolescents. The purpose of this study is to compare between skeletal maturity and chronological age. The second purpose of this study is to clarify the lesions of the lumbar endplate based on the maturation of the lumbar vertebral body. Six hundred and thirty-two (485 men and 147 women) consecutive patients were included. The mean age at the first medical examination was 13.8years. Their skeletal maturity was evaluated based on the appearances of the secondary ossification center of L3. The area of the endplate lesions was classified into five types. The apophyseal stage was observed from 10years old to 18years old, and the apophyseal stage was shown the peak at 14years old. The appearance of the apophyseal ring was observed earlier in female patients than in male patients. For the concave type, the lesion at upper level vertebra was more prevalent. The anterior and middle type of the lesion at upper level vertebra was more prevalent. For the posterior type, the lesion of the inferior rim of L4 and the lesion of the rim of L5 were more prevalent. This study emerged after comparing skeletal maturity based on the maturation of the lumbar vertebral body with the chronological age of a large number of patients and examining the lesions of the lumbar endplate based on the stage of maturation of the lumbar vertebral body.

TOMOGRAPHIC ANALYSIS OF SUBAXIAL CERVICAL VERTEBRAE IN CHILDREN BETWEEN 0 AND 12 YEARS

ABSTRACT Objective: Tomographic and anatomic analysis of cervical vertebrae in children from 0 to 12 years of age to verify the possibility of utilization of lateral mass screws. Methods: Twenty-five cervical spine tomographies of children between 0 and 12 years of age, admitted to the emergency room of Hospital das Clínicas of São Paulo were retrospectively analyzed. The following distances were measured: width and length of the lateral masses in the axial section; width and height in the coronal section; height, length and diagonal diameter in the sagittal section. The variables studied were correlated with age and sex and submitted to statistical analysis. Results: The analysis of tomographic measurements of 20 patients showed a correlation between age and dimensions of the lateral mass, which were higher after 6 years of age. In relation to sex, greater measures were observed in males in all axes. With regard to the passage of the screws, we only had 22 masses (11%) that prevented their use. However, when stratified by age, we noticed that no patients had restrictions on the use of the lateral mass screw after the age of 6. Conclusion: This study analyzed the measurements of 200 lateral masses, making it possible to infer that there is an increase of dimensions with age and in males. Through the data, it was possible to affirm that in this sample, considering the implants available in the market, the lateral mass screws could be used in 89% of the lateral masses.

EARLY ORTHOTICS IN COMPLEX TREATMENT OF CHILDREN WITH VERTEBRAL COMPRESSION FRACTURES OF THE THORACIC AND LUMBAR SPINE

Objective. To compare the results of treatment of compression fractures of the thoracic and lumbar vertebrae in children by classical functional extension and by early orthotics with hyperextension braces. Material and Methods . The study included 175 children aged 3 to 18 years with vertebral compression fractures of the thoracic and lumbar spine. In the study group (32 patients), early orthotics with a rigid hyperextension brace was used, in the control group (143 patients) - a standard Gorinevskaya - Dreving’s technique followed by wearing a semi-rigid brace. Results . In the study group, the average vertebral compression ratio was 63 %, WI - 0.6-0.8, and vertebral body height restoration was observed in 90.5 % of cases. In the control group, the average compression ratio was 75 %, WI - 0.75-0.9, and abnormal wedging of vertebral bodies after the treatment was observed in 48.0 % of patients. In the study group, the length of hospital stay was reduced, the mode of physical activity in the early stages was increased with better and faster restoration of vertebral bodies in comparison with the control group. Conclusion . Application of hyperextension braces shortens hospital stay, contributes to the complete restoration of the height and shape of the damaged vertebral body, and allows for more early returning the children to the familiar social environment.

3D-CT analysis of anatomical and anthropometric parameters of vertebrae in children with Lenke type V idiopathic scoliosis

Objective . To analyze anatomical and anthropometric parameters of vertebrae in children with Lenke type V idiopathic scoliosis using 3D-CT navigation. Material and Methods . The study included 15 patients aged 14-18 with thoracolumbar/lumbar idiopathic scoliosis of grades III and IV according to V.D. Chaklin. Anatomic and anthropometric features of the thoracic and lumbar vertebrae were assessed based on CT data in the navigation system. The total Cobb angle of the scoliotic curve, rotation of the apical and periapical vertebrae, external transverse and longitudinal diameters of the pedicles at the T 2 -L 5 levels, and the coefficients of asymmetry of vertebral bone structures were determined. Results . The angle of scoliosis ranged from 39.8° to 84.3° (average - 59.5°), the angle of rotation of the apical vertebra - from 17.7° to 50.5° (average - 34.6°). Anatomical dimensions of the transverse and longitudinal diameters of the pedicles on the concave and convex sides at the apex of a primary curve exceeded 4.0 mm. A strong correlation between the apical vertebral rotation, the Cobb angle, and the coefficient of asymmetry of longitudinal diameters of the pedicles of the apical vertebra was revealed. The coefficient of asymmetry of pedicle areas is an integral indicator of the severity of asymmetry in scoliosis. Conclusion . A different degree of asymmetry of the bone structures of the main arch apical vertebrae was revealed in the thoracic and thoracolumbar/lumber scoliosis.

TOMOGRAPHIC ANALYSIS OF T-1 VERTEBRA TO INSERT LAMINAR SCREWS IN CHILDREN FROM 0 TO 12 YEARS

Objective : Tomographic analysis of the T1 vertebra in children from 0 to 12 years of age, in order to obtain anatomical parameters that assist intralaminar fixation in this pediatric population. Methods : Retrospectively analysis of the spine with CT (cervical and thoracic) of individuals aged between 0 and 12 years old, of both sexes, without anatomical deformities. The CT scans were evaluated separately, on each side, for length and thickness of the laminas as well as spinolaminar angle. The morphometric analysis was performed with iSite PACS Philips Healthcare Informatics(r) program and the values were expressed in millimeters (mm). The variables were correlated with age groups and sex of individuals. Statistical analysis was performed using t test and the results were considered significant when p&lt;0.05. Results : By means of tomographic analysis of 24 patients it was found that age has no correlation with the angle of attack for intralaminar screws T1. However, the length and thickness of the T1 lamina increase proportionally with age. The total average length of the laminas was 28.62 ± 4.42 mm. The total average thickness was 4.75 ± 0.95 mm (3.2 to 6.5). Conclusion : This study shows relevant data on the use of Tran laminar screws currently commercially available with a minimum thickness of 3.5 mm. It is thus possible to say in this sample, they can be used in 87.5% of all laminas, being applicable in all lamina in patients older than 44 months of age.

Feasibility of atlantoaxial pedicle screws’ placement in children 6–8 years of age

The aims of this study were to evaluate the linear and angular dimensions of children's atlantoaxial pedicle using cadavers combined with axial computed tomography (CT) and to examine the feasibility of placing atlantoaxial pedicle screws (3.5 mm diameter) on the vertebrae of children 6-8 years of age. Fourteen cadaveric specimens, ranging in age from 6 to 8 years, were dissected to obtain their atlantoaxial vertebrae. We manually measured 12 linear anatomic parameters related to the atlantoaxial pedicle, its lateral mass, and the posterior arch under the vertebral artery groove. CT axial scanning of the atlantoaxial region was performed on 32 healthy children ranging in age from 6 to 8 years. The length of the atlantoaxial pedicles and the angle between the pedicle axis and the midline of the vertebral body were measured on the atlantoaxial transverse CT imaging. It is feasible to place a 3.5 mm screw in the atlantoaxial pedicle of children ranging in age from 6 to 8 years when the appropriate entry point and trajectory of the screw are chosen.

Ossification Patterns of the Atlas Vertebra

The objective of this study was to characterize ossification patterns of the C1 (atlas) vertebra in children, to better differentiate normal variants from traumatic injury. A retrospective review of all sinus and temporal bone CT examinations was performed for the period of 2002-2009. Patients 96 months old or younger for whom C1 level was at least partially imaged were included. Patients with a history of trauma or genetic disorder-associated spinal abnormalities were excluded. A total of 1270 CT examinations were reviewed. The anterior arch of C1 was completely imaged in 841 patients (66%), and the posterior arch was completely imaged in 378 patients (30%). Multiple anterior arch ossification centers were observed in 179 of 841 patients (21%), and posterior arch variants were present in nine of 378 patients (2%). At least partial ossification of the anterior arch was seen in 113 of 147 children (77%) younger than 25 months, whereas only 14 of the remaining 694 children (2%) older than 24 months failed to show any ossification. Incomplete ossification of the anterior arch was noted in 47 of 103 patients (46%) in the 85-96-month-old category. The posterior arches were at least partially ossified in all children. Incomplete fusion of the posterior synchondrosis was seen in 17 of 108 patients (16%) older than 60 months. C1 ossification patterns and timing of synchondrosis fusion are variable. Knowledge of these patterns is important to better differentiate a normal variant from traumatic injury.

Considerations in the finite element modelling of vertebrae in children and adults: a preliminary study

Click to increase image sizeClick to decrease image sizeKeywords: boneagevertebrafinite element modellingsensitivity study Acknowledgements This research was funded by NSERC (Canada) and INRETS (France).