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Pediatric Cervical Spine: Normal Anatomy, Variants, and Trauma¹

¹ From the Department of Radiology, Long Island Jewish Medical Center, 270-05 76th Ave, New Hyde Park, NY 11040 (E.S.L., S.P.K., J.C., K.V., J.H.B., A.S.D., S.S.); the Department of Radiology, Winthrop University Hospital, Mineola, NY (A.O.O.); the Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC (M.C.); and the Department of Radiology, North Shore University Hospital, Manhasset, NY (K.B.). Presented as an education exhibit at the 2001 RSNA scientific assembly. Received July 10, 2002; revision requested August 21 and received December 9; accepted January 29, 2003. Address correspondence to S.P.K. (e-mail: otter102@earthlink.net).

Emergency radiologic evaluation of the pediatric cervical spine can be challenging because of the confusing appearance of synchondroses, normal anatomic variants, and injuries that are unique to children. Cervical spine injuries in children are usually seen in the upper cervical region owing to the unique biomechanics and anatomy of the pediatric cervical spine. Knowledge of the normal embryologic development and anatomy of the cervical spine is important to avoid mistaking synchondroses for fractures in the setting of trauma. Familiarity with anatomic variants is also important for correct image interpretation. These variants include pseudosubluxation, absence of cervical lordosis, wedging of the C3 vertebra, widening of the predental space, prevertebral soft-tissue widening, intervertebral widening, and "pseudo–Jefferson fracture." In addition, familiarity with mechanisms of injury and appropriate imaging modalities will aid in the correct interpretation of radiologic images of the pediatric cervical spine.

© RSNA, 2003

Index Terms: Spine, anatomy, 31.92 • Spine, CT, 31.1211 • Spine, diseases • Spine, dislocation, 31.42, 31.4211 • Spine, fractures, 31.41 • Spine, injuries • Spine, MR, 31.1214 • Spine, radiography, 31.11

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