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Cervical spine alignment in the pediatric population: a radiographic normative study of 150 asymptomatic patients

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Abstract

Purpose

To describe the normal cervical sagittal alignment of the pediatric spine in a normal population and to identify the changes during growth period.

Methods

We randomly selected in PACS database 150 full-spine standing views. Exclusion criteria were: age >18 years, spinal deformity and any disease affecting the spine (medical charts reviewing). For cervical alignment we measured: OC-angle according to Mc Gregor, C1C7 angle, upper cervical angle, inferior cervical angle and C7 tilt. Spino pelvic parameters were analyzed: T1 tilt, thoracic kyphosis, lumbar lordosis, pelvic incidence, sacral slope and pelvic tilt. We compared two age subgroups (juvenile and adolescent). Differences between age groups and gender were tested using Student’s t test. Correlations between sagittal spinal parameters were evaluated using Pearson’s test.

Results

Cervical spine shape was correlated to cranio cervical orientation to maintain horizontal gaze (r = 0.60) and to thoracic kyphosis (r = −0.46). Cervical spine alignment was significantly different between the two age groups except for the global C1C7 cervical lordosis, which remained stable. A significant gender difference was found for all the cervical sagittal angles (p < 0.01) whereas no differences were demonstrated for the spino pelvic parameters, except the lumbar lordosis (p = 0.047).

Conclusions

This study is the first to report the cervical spinal alignment in a normal pediatric Caucasian population. Even though cervical lordosis is the common shape, our results showed variability in cervical sagittal alignment. Cervical spine is a junctional area that adjusts its alignment to the head position and to the underlying spinal alignment.

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Acknowledgments

We thank all the members of the Cervical Spine Study Group for their collaboration in the critical analysis of our work. This work has not receive any funds or grants.

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Authors and Affiliations

  1. Department of Pediatric Orthopedic Surgery, Hôpital Femme Mère Enfant, Université Claude Bernard Lyon I, Hospices Civils de Lyon, 59, Boulevard Pinel, Bron Cedex, 69677, Lyon, France

    K. Abelin-Genevois, A. Idjerouidene & C. Garin

  2. Department of Orthopedic Surgery, Centre Médico-Chirurgical de Réadaptation des Massues, Lyon, France

    P. Roussouly

  3. Spine Surgery Unit, Pellegrin University Hospital, Bordeaux, France

    J. M. Vital

  4. Cervical Spine Study Group, Groupe d’Etude sur la Scoliose (GES), Paris, France

    K. Abelin-Genevois, P. Roussouly, J. M. Vital & C. Garin

Authors
  1. K. Abelin-Genevois
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  2. A. Idjerouidene
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  3. P. Roussouly
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  4. J. M. Vital
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  5. C. Garin
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Correspondence to K. Abelin-Genevois.

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Abelin-Genevois, K., Idjerouidene, A., Roussouly, P. et al. Cervical spine alignment in the pediatric population: a radiographic normative study of 150 asymptomatic patients. Eur Spine J 23, 1442–1448 (2014). https://doi.org/10.1007/s00586-013-3150-5

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  • DOI: https://doi.org/10.1007/s00586-013-3150-5

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