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Sex-specific differences in ossification patterns of the atlas and axis: a computed tomography study

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Abstract

Background

We investigated the sex-specific differences in ossification patterns of the first two cervical vertebrae in Chinese children.

Methods

A retrospective computed tomography (CT) study was performed between June 2016 and December 2020. Patients younger than 16 years with cervical CT images acquired ≤ 1.5 mm slice thickness were included. All eligible patients were stratified into 2 sex groups and 16 age groups based on 1-year intervals. The ossification status of each synchondrosis and ossification variants were evaluated.

Results

A total of 910 subjects (518 males and 392 females) were included in the study. For the C1 vertebra, the neurocentral synchondroses closed at a median age of 8 years in males and 6.3 years in females, and the posterior synchondrosis fused at 5.4 years in males and at 4.4 years in females. Multifocal anterior arch ossification centers were present in 74 of 411 (18%) subjects, whereas posterior arch variants were observed in 18 of 258 (7%) subjects. For the C2 vertebra, the sequence of complete fusion was as follows: posterior synchondrosis, neurocentral synchondroses, and dentoneural synchondrosis. Uniquely, a fusion line was observed in the dentocentral synchondrosis through adolescence. Anterior arch variants of the C2 vertebra occurred in 17 of 248 (6.9%) subjects. There was no significant difference between the sexes in ossification variants.

Conclusions

All synchondroses of the first two cervical vertebrae fuse slightly earlier in females. The sequence of fusion follows a posterior-to-anterior and caudal-to-cephalad pattern in both sexes. Congenital variants are not rare and should not be confused with trauma.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Wei-Liang Wu, Xiao-Bo Shao, Yi-Guo Shen & Jian-Song Chen

  2. Department of Cardiac Surgery, Children’s Hospital, Zhejiang University School of Medicine, Administrative Building, No. 3333 Binsheng Road, Hangzhou 310052, China

    Qiang Shu

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  1. Wei-Liang Wu
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  2. Xiao-Bo Shao
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  3. Yi-Guo Shen
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Contributions

SQ contributed to conceptualization, methodology, and supervision. WWL contributed to conceptualization, investigation, data curation, writing of the original draft, review and editing. SXB contributed to investigation, methodology, data curation, software, and writing of the original draft. SYG contributed to investigation, methodology, and data curation. CJS contributed to conceptualization, supervision, methodology, and data curation. All authors have read and approved the final version of the manuscript.

Corresponding author

Correspondence to Qiang Shu.

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Ethical approval

The study was approved by the Ethical Review Committee of the Children's Hospital, Zhejiang University School of Medicine (2021-IRB-146). The requirement for informed consent was waived, as all patient identification information was removed after the data were collected and analyzed.

Conflict of interest

No financial or non-financial benefits have been received or will be received from any party related directly or indirectly to the subject of this article. Author Qiang Shu is the Chief Editors for World Journal of Pediatrics. The paper was handled by the other Editor and has undergone rigorous peer review process. Author Qiang Shu was not involved in the journal's review of, or decisions related to, this manuscript.

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Wu, WL., Shao, XB., Shen, YG. et al. Sex-specific differences in ossification patterns of the atlas and axis: a computed tomography study. World J Pediatr 18, 263–270 (2022). https://doi.org/10.1007/s12519-022-00523-7

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  • DOI: https://doi.org/10.1007/s12519-022-00523-7

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