Radiology of the Growing Cervical Spine

The evaluation of the developing pediatric cervical spine presents certain diagnostic dilemmas that are not encountered in adults. There are several well-documented radiographic pitfalls that can lead physicians to misinterpret normal anatomical variations for true pathologic changes. Physeal variations, unique vertebral architecture, incomplete ossification, and hypermobility of the cervical spine may all cause uncertainty when interpreting radiographs of a child with a history of trauma, pain, or stiffness. There are various radiographic measurements that can be utilized to differentiate true pathology from normal variants; however knowledge of the embryological development and postnatal ossification patterns of the cervical spine is paramount in recognizing traumatic spinal injuries in children. Although cervical spine injuries in children are rare, they are associated with high morbidity and mortality. Therefore understanding the normal appearance of the developing pediatric cervical spine as well as the presentation of pathological changes on plain films, CT, and MRI is essential in ensuring early and accurate diagnosis.