Imaging of the Cervical Spine in Children

116 Pages·2013·7.748 MB·English

by  Leonard E. Swischuk (auth.)

S Leonard E. Swischuk
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2nd Ed.
Imaging of the Cervical Spine in Children

Leonard E. Swischuk
Imaging of the Cervical
Spine in Children
Second Edition
Leonard E. Swischuk, MD
Department of Pediatric Radiology
University of Texas Medical Branch
Galveston, TX, USA
ISBN 978-1-4614-3787-1 ISBN 978-1-4614-3788-8 (e-book)
DOI 10.1007/978-1-4614-3788-8
Springer New York Heidelberg Dordrecht London
Library of Congress Control Number: 2012941756
© Springer Science+Business Media New York 2013
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To Janie, my wife
my life, my love, and my anchor
for over fi fty years

Preface
When I fi rst got into Pediatric Radiology in the 1960s and then when I moved
to UTMB in Galveston, Texas in 1970, I became more and more interested in
the cervical spine. I realized that in the pediatric age group, interpretation of
the cervical spine images was often a problem for everyone, including myself.
The reason for this was that there are many normal physiologic and anatomic
variations that frequently mimic pathology, and at times this would become
confusing.
F ortunately, shortly after arriving in Galveston, I came across a mono-
graph entitled T he Upper Cervical Spine, authored in 1972 by Detlef von
Torklus and Walter Gehle from the orthopedic clinic and outpatient department
at University Hospital in Hamburg Germany. This book was excellent in
explaining anatomic and physiologic phenomena and was of great help for
me. I then went on to look at things such as physiologic subluxation of C2 on
C3, wedging of C3 and C4, the predental distance, and the differences in
fractures sustained under the age of 5 from those sustained in older children
and adults. Slowly, I began to feel more comfortable with the C-Spine and
started to publish articles on it and also write chapters and textbooks. To this
date, the lectures that I am asked to do most often are “The Cervical Spine:
What Is Normal and What Is Abnormal,” and another lecture on the same
topic with a slightly different title, “The Cervical Spine in Children: When to
Worry?”
Although all of this started with plain fi lms, many of the fi ndings are now
readily transferable to CT and MR, especially Sagittal reconstructed views on
CT. Therefore, I have attempted to blend the fi ndings on plain fi lms with
those seen on CT and MR and emphasize which imaging modality produces
best results, for any given condition. In addition, there is constant emphasis
on normal anatomic and physiologic phenomena that mimic pathology.
Finally, I would like to thank my secretary Shirl Veal for all her assistance
with this book. She is always up to any challenge and performs her duties
with expertise and promptness. I am indebted to her for all the help she has
given me in preparing this book.
Galveston, TX, USA Leonard E. Swischuk, MD
vii

Contents
1 Developmental Anatomy ................................................................ 1
Normal Synchondroses ..................................................................... 2
References ......................................................................................... 9
2 Normal Variations ........................................................................... 11
Vertebral Bodies and Neural Arches ................................................. 11
Normal Cervical Spine Motion Causing Pseudoabnormalities ........ 11
High Anterior Arch of C1 ................................................................. 12
Exaggerated C1–C2 Interspinous Distance ...................................... 12
C1-to-Dens (Predental Distance) ...................................................... 13
Posterior Dislocation of Vertebral Bodies ......................................... 13
Anterior Angulation of C2 on C3 ..................................................... 13
Anterior Dislocation of C2 on C3 ..................................................... 14
Wedging of C3 and C4 ...................................................................... 16
Normal Apophyseal Joints: Older Child ........................................... 17
Prevertebral Soft Tissues ................................................................... 18
Ring Epiphysis .................................................................................. 18
Transverse Process Projection Over Disk Spaces ............................. 20
Pseudowidening of the Spinal Canal ................................................ 20
Positioning Pseudofractures of the Upper Cervical Spine ................ 23
Bilateral Offset Lateral Masses of C1
(Increase in Dens–Lateral Mass Distance) ....................................... 23
Unilateral Offset Lateral Mass of C1
(Increased Unilateral Dens–Lateral Mass Distance) ......................... 26
Central Veins ..................................................................................... 27
Posticus Ponticus .............................................................................. 27
References ......................................................................................... 29
3 Anomalies ......................................................................................... 31
Fusion–Segmentation Anomalies ..................................................... 31
Fusion Anomalies of Vertebral Bodies ............................................. 31
Posterior C1 Arch Defects ................................................................ 34
Posterior C2 Arch Defects ................................................................ 34
Posterior Arch Defects: Lower Vertebra ........................................... 38
Anterior Arch Defects of C1 ............................................................. 38
Dysplastic Neural Arches ................................................................. 39
References ......................................................................................... 44
ix