Pediatric emergency medicine trisk 3596 3596
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TABLE 112.7
RADIOGRAPHIC CHARACTERISTICS OF PEDIATRIC CERVICAL
SPINE
Cartilage artifact
Tapered anterior vertebrae
Apparently absent ring of C1
Atlas (C1) body not ossified at birth and may fail to close
Axis (C2) has four ossification centers
Apex of odontoid ossifies between 12 and 15 yrs of age
Spinous process ossification centers
Increased mobility
Pseudosubluxation
C1 override on dens
Increased predental space (5 mm maximum)
Ligament laxity
Facet joints shallow
Growth plates (synchondrosis)
Dens ossifies between 3 and 8 yrs of age (may persist into young adults)
Posterior arch of C1 ossifies at 3 yrs of age
Anterior arch of C1 ossifies at 6–9 yrs of age
C1 reaches adult size at 3–4 yrs of age
C2 through C7 reach adult size at 5–6 yrs of age
Lack of cervical lordosis
Fulcrum varies with age
Soft tissue variability with respiration
Congenital clefts or other bony abnormalities (os odontoideum,
spondylolisthesis, spina bifida, ossiculum terminale)
The bones should be evaluated for typical abnormalities, realizing that these
may be subtle. Acute fractures are often irregular in location and appearance
without sclerosis as compared with the more routine locations and appearance of
cartilaginous growth areas. The clinician should be aware that structures that
overlay the spine, including the skull and the teeth, might simulate fractures.
If further information about C1–C2 or any other portion of cervical spine is
required, a CT scan should be considered. While it is more expensive than a plain
radiograph, it is relatively easy to obtain, offers enhanced and more consistent
