TY - JOUR T1 - Analysis of Upper Cervical Spine Measurements in the Uninjured Pediatric Spine JF - International Journal of Spine Surgery JO - Int J Spine Surg SP - 458 LP - 464 DO - 10.14444/8248 VL - 16 IS - 3 AU - Joseph F. Baker Y1 - 2022/06/01 UR - http://ijssurgery.com//content/16/3/458.abstract N2 - Background Only a small number of studies have offered normative data for the upper cervical spine in children and with some variation in findings.Objective The aim of this study was to determine normal values for upper cervical spine measurements used in the assessment of upper cervical spine trauma in the pediatric population.Methods One-hundred computed tomographic images of the cervical spine of children aged ≤16 years were included for analysis. All children were cleared of spinal injury. Anterior atlanto-dens interval (ADI), posterior atlanto-dens interval (PADI), basion-dens interval (BDI), Powers ratio, condylar-C1 interval (CCI), and lateral mass interval (LMI) were measured on the relevant sagittal or coronal images. Measurements for CCI and LMI were taken on each side.Results Mean age was 111 months (range 11–196 months). Sixty-two were male. Mean values (and ranges) of the measurements were as follows: BDI: 7.1 mm (3.6–12.2); ADI 2.8 mm (0.8–4.8); PADI 18.7 mm (14.1–23.2); Powers ratio 0.72 (0.59–1.0); CCI 2.0 and 2.0 (0.5–4.2); and LMI 3.2 and 3.3 mm (1.7–4.8). BDI (r = −0.488), ADI (r = −0.201), PADI (r = 0.264), and CCI (r = −0.468 and −0.454) all showed significant correlation with age. The Powers ratio was the most stable measurement across all age groups.Conclusions Normal values were reported from a local pediatric population with a wide age range. Most values correlate with age to a degree, and so normal values may vary throughout childhood. A multicenter study is desirable to advance knowledge in this field.Clinical Relevance Current radiographic measures used to assess for possible ligamentous injury in the pediatric upper cervical spine correlate with age. Caution must be held when analyzing the upper cervical spine across a range of age groups in children.Level of Evidence 4. ER -