Measurements in cervical vertebrae CT of pediatric cases: normal values

C1-C2 subluxation in enthesitis-related arthritis: two case reports and literature review of ten cases

BACKGROUND

C1-C2 subluxation is a rare complication of enthesitis-related arthritis (ERA). If left untreated, it may lead to functional impairment or cervical spinal cord compression. This study aims to highlight key points regarding the management of C1-C2 subluxation in ERA.

CASE PRESENTATION

We present two cases of C1-C2 subluxation: an 8-year-old boy with ERA and 16-year-old boy with ERA with bilateral sacroiliitis. Ten cases of ERA in the literature were reviewed. The diagnosis of C1-C2 subluxation is mostly based on radiographs and cervical spine computed tomography. All patients were treated with non-steroidal anti-inflammatory drugs. Six ERA patients were treated surgically for cervical fusion. Most ERA patients with sacroiliitis had cervical collar protection. Neurologic abnormalities after treatment were not reported. Despite the use of cervical collar, cervical fusion and persisting ankylosis were found in two ERA patients with sacroiliitis without surgical treatment.

CONCLUSIONS

Cervical spine protection and ruling out spinal cord compression should be prioritized, in addition to controlling the underlying inflammation in ERA. Cervical halter traction may be applied after severe cervical inflammation is excluded. To reduce the risk of complications, early recognition and appropriate treatments of C1-C2 subluxation in ERA are essential.

Cone beam computed tomography evaluation of the relationship between atlantodental interval and skeletal facial morphology in adolescents

Introduction

In the pediatric population, computed tomography examination of the upper cervical spine plays an important role in the diagnosis of neurological injuries involving that region. Due to the interconnected nature of the craniofacial structures, a structural change in one is expected to also cause changes in the other structures.

Objective

The aim of this study was to evaluate relationships between atlantodental interval, cervical vertebral morphology, and facial structure in healthy adolescents using cone beam computed tomography.

Methods

Thirty subjects aged 14–20 years (10 males, mean age: 17.2 years; 20 females, mean age: 17.9 years) were included in the study. The anterior, lateral and posterior atlantodental intervals, and vertical and anteroposterior dimensions of the first and second cervical vertebrae were evaluated from cone beam computed tomography images. Facial morphology was evaluated using 7 parameters on lateral cephalometric cone beam computed tomography images and 6 parameters on posteroanterior images. The Mann–Whitney U test and Wilcoxon test were used for statistical analyses.

Results

Comparisons between males and females showed that most parameters were larger in males, with significant differences in vertical facial dimensions (anterior lower face height: p = 0.05; anterior upper face height: p = 0.001), (distance between the most internal point of the frontozygomatic suture and midsagittal reference plane; p = 0.01), (the distance between the deepest point of the right alveolar maxillar process and midsagittal reference plane; p = 0.001), and C2 vertebral dimensions. The anterior and lateral atlantodental interval values correlated with maxilla position relative to the mandible angle, and the anterior atlantodental interval correlated with lower anterior facial height (p = 0.05). Dimensional measurements of the C1 and C2 vertebrae were correlated with both anterior facial heights and some posteroanterior parameters.

Conclusion

Sagittal, vertical, and transverse facial dimensions and positions were strongly associated with C1 and C2 vertebral dimensions, and the maxillomandibular relationship may affect atlantodental interval. Therefore, including craniofacial features in assessment of the atlantodental area and vertebral distances in adolescents may be beneficial.