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Digital anatomical features of morphological development in C2–C7 neurocentral synchondrosis in children aged 1–6 years: a retrospective study of CT images

European Journal of Medical Research volume 29, Article number: 424 (2024) Cite this article

Abstract

Background

With the continuous improvement of diagnosis and treatment technology for cervical spine-related diseases in children at home and abroad, the demand for exploring the developmental anatomy and function of children's cervical spine of different ages is increasing. So the aim of this study was to investigate the changes of anatomical indicators in neurocentral synchondrosis (NCS) of C2–C7 with age and the developmental characteristics of different vertebrae in children aged 1–6 years old.

Method

A retrospective collection of 160 cases of normal cervical spine CT images of children aged 1–6 years old in provincial tertiary hospitals, according to the age group of 1-year-old into 6 groups. The original data of continuously scanned cervical spine tomography images were imported into Mimics16.0 software, under the two-dimensional image window, selected the measurement tool under the Measurements toolbar to measure and statistically analyzed the anatomical indicators such as cross diameter, sagittal diameter, height, perimeter and area of NCS in the C2–C7 segment of the cervical spine on the coronal plane and cross-section.

Results

There was no significant difference in the anatomical indexes of cervical spine NCS in children compared with the left and right sides of the same vertebrae (P > 0.05). The same cervical spine generally had differences between the age groups of 1–4 years old and 5–6 years old (P < 0.05).The transverse diameter and circumference gradually decreased with age; the sagittal diameter and height showed a slight increase trend; there was a maximum area at 2 years of age. In different cervical vertebrae of the same age group, the NCS values of C3, C4, and C5 varied greatly, which showed that the ossification process of cervical cartilage was faster than that at the upper and lower ends. There were obvious differences between C2 and the rest of the cervical vertebral segments’ NCS ossification process. C7 was also very different from the rest of the cervical vertebrae segments, presumably more similar to the thoracic spine.

Conclusions

The anatomical indexes of C2–C7 NCS in children have obvious developmental regularities at different ages, and there are also regularities between cervical segments.

Introduction

The development process of the human cervical vertebra is complex, and it is also a common site for congenital malformation [1]. Neurocentral synchondrosis (NCS) is a conjunctional cartilage located at the junction of the vertebral arch and the vertebral body, which plays an important role in the normal growth of the vertebral body and the vertebral arch [2]. In the cervical vertebra, NCS only appears in C2–C7 segments [3], while the cartilage of the atlas is relatively special and lacks NCS. Scholars at home and abroad have conducted more studies on the cartilage of the atlas, while relatively few studies have been conducted on the anatomy of NCS in the cervical vertebra at C2–C7 segments [4]. Previous studies only focused on the closing age but did not explain the normal growth characteristics of NCS [5]. At present, little is known about the growth and development anatomical characteristics of NCS in normal children's C2–C7 cervical vertebrae. There are still questions about the growth direction of NCS at different segments with age and whether the growth characteristics of NCS at different segments of the spine are the same, which makes us confused about the characteristics of C2–C7 cervical NCS in normal spinal growth or the development of spinal deformity [6].

In this study, 160 normal children with C2–C7 cervical NCS CT imaging data were collected. Based on the CT imaging data, the anatomical parameters of NCS in different cervical segments of children were measured. The anatomical and developmental characteristics of NCS in different cervical segments of C2–C7 were discussed to guide clinical application and imaging diagnosis.

Materials and methods

Materials

The neck CT images and case data of children aged 1–6 between January 2017–December 2021 were retrospectively collected from provincial tertiary hospitals, and the C2–C7 imaging CT data of 160 patients were selected through inclusion criteria. According to the age group of 1 year, it was divided into six groups (Table 1). The informed consent of the guardian of the volunteer aged 1–6 years old groups has been obtained.

Table 1 Research groups
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Inclusion criteria: No previous cervical spine dysplasia and intraspinal lesions; no obvious trauma or injury to the cervical spine; no history of cervical spine lesions and surgery; the image data were taken in a normal position; and there was no abnormal position, such as side bend and turning head.

Methods

Inspection position and inspection equipment

Used 64-row spiral CT scanner (GE Company, USA) to scan cervical head-to-toe direction, the scanning line was perpendicular to the body axis. Scanning parameters: layer thickness 1.25 mm, layer spacing 1.25 mm, scanning time 0.4 s, ball tube voltage 120 kV, current 200 mA, 512 × 512 matrix imaging, scanning imaging field 15 cm × 15 cm, pixel size 0.625 × 0.625.

Technology and method for the measurement of morphological parameters

Raw data of the continuously scanned cervical tomography images were imported into Mimics16.0 software in DICOM format (Materialise interactive medical image control system, Materialise, Belgium). Under the two-dimensional image window, selected the measurements tool to measure the morphological parameters of NCS on the coronal and cross-sections of the cervical spine.

Main observation indicators

Measured cervical NCS-related indicators in the cross-section and coronal surface. Each indicator was measured three times and the average value taken. The data accuracy was 0.10 mm, and the allowable error range was ± 0.10 mm. Cross section: Based on the center of the vertebral body, the vertebral body was divided into cross-sections of equal height; coronal plane: based on the center of the vertebral body, the vertebral body was divided into cross-sections with equal sagittal diameters. The anatomical indexes of C2–C7 NCS were measured, including the transverse diameter of neurocentral synchondrosis, the sagittal diameter of neurocentral synchondrosis, the area of neurocentral synchondrosis, the perimeter of neurocentral synchondrosis, and the height of neurocentral synchondrosis (Table 2, Figs. 1, 2).

Table 2 Name, measurement method, and abbreviations of anatomical indicators of C2–C7 NCS
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Fig. 1
figure 1

Measurement diagram of C2 NCS: a the C2 NCS on the transverse section; b the C2 NCS on the coronal plane; c the transverse diameter of the C2 NCS; d the sagittal diameter of the C2 NCS; e the area and the perimeter of the C2 NCS; f the height of the C2 NCS

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Fig. 2
figure 2

Measurement diagram of C3–C7 NCS: a the C3–C7 NCS on the transverse section; b the C3–C7 NCS on the coronal plane; c the transverse diameter of the C3–C7 NCS; d the sagittal diameter of the C3–C7 NCS; e the area and the perimeter of the C3–C7 NCS; f the height of the C3–C7 NCS

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Statistical analysis

Statistical analysis was performed using SPSS 22.0 software and measurement data were expressed as \(\overline{x }\)±s. One-way ANOVA was used when the data satisfied the normal distribution and the variance was homogeneous, the LSD test was used for pairwise comparisons within the group, and the Kruskal–Wallis test was used for nonparametric test for uneven variance. It was significant to establish that the test level was α = 0.05, and the difference was significant with P < 0.05.

Results

Comparison of the NCS transverse diameter

The transverse diameter anatomic indexes of C2–C7 NCS were measured and the transverse diameter values decreased gradually with the increase of age. The transverse diameter values of the left and right sides of the same vertebral body at the same age had similar changes, and there was no statistical difference between the two sides (P > 0.05). In the comparison of different vertebral bodies in the same age group, the left and right lateral transverse diameter values of group 2 were statistically different between C3 and C5–C7 (P < 0.05). The left and right lateral transverse diameter values of group 6 were statistically different between C2, C6–C7 and C3 (P < 0.05). In the comparison of different age groups in the same vertebral body, except for C3, the left and right transverse diameter values of C2–C7 were statistically different between groups 1–2 and groups 4–6 (P < 0.05). The left and right cross-diameter values of C2–C7 were statistically different between group 3 and groups 5–6 (P < 0.05) (Table 3, Figs. 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14).

Table 3 NCS in different cervical segments in each age group comparison of the anatomical indicators
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Fig. 3
figure 3

Trend chart of NCS anatomical indexes in all groups of C2

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Fig. 4
figure 4

Trend chart of NCS anatomical indexes in all groups of C3

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Fig. 5
figure 5

Trend chart of NCS anatomical indexes in all groups of C4

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Fig. 6
figure 6

Trend chart of NCS anatomical indexes in all groups of C5

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Fig. 7
figure 7

Trend chart of NCS anatomical indexes in all groups of C6

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Fig. 8
figure 8

Trend chart of NCS anatomical indexes in all groups of C7

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Fig. 9
figure 9

Trend of anatomical indexes of NCS at each cervical spine segment at group 1

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Fig. 10
figure 10

Trend of anatomical indexes of NCS at each cervical spine segment at group 2

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Fig. 11
figure 11

Trend of anatomical indexes of NCS at each cervical spine segment at group 3

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Fig. 12
figure 12

Trend of anatomical indexes of NCS at each cervical spine segment at group 4

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Fig. 13
figure 13

Trend of anatomical indexes of NCS at each cervical spine segment at group 5

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Fig. 14
figure 14

Trend of anatomical indexes of NCS at each cervical spine segment at group 6

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Comparison of the NCS sagittal diameter

The anatomical index of the sagittal diameter of C2–C7 NCS showed that the sagittal diameter value first increased and then decreased with age, but there was a maximum value in groups 4–5. The left and right sagittal diameter values of C3 were larger than those in other vertebral bodies. The sagittal diameter values of the left and right sides of the same vertebral body at the same age had similar amplitudes, and there was no statistical difference between the two sides (P > 0.05). In the comparison of different vertebral bodies in the same age group, the left and right sagittal diameter values of group 5 were statistically different between C2, C5, C6 and C3 (P < 0.05). The left and right sagittal diameter values of group 6 were statistically different between C2, C4–C6 and C3 (P < 0.05). In the comparison of different age groups of the same vertebral body, there was a statistical difference between group 6 and group 4 of the NCS sagittal diameter values on the left and right sides of C4 (P < 0.05) (Table 3, Figs. 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14).

Comparison of the NCS height

The height anatomical index measurement of C2–C7 NCS showed that the height value roughly increased gradually between 1–6 years old, and there was a maximum value between groups 5–6. The height value of the left and right sides of C2 was larger than that of other vertebral bodies. The change range of NCS height values on the left and right sides of the same vertebral body at the same age was similar, and there was no statistical difference between the two sides (P > 0.05). In the comparison of different vertebral bodies of the same age, the left and right height values of groups 2–6 were statistically different in C3–C6 and C2 (P < 0.05). In the comparison of different age groups of the same vertebral body, the left and right height values of C2 value were statistically different between group 1 and groups 3–6 (P < 0.05). The left and right height values of C3 were statistically different between group 6 and groups 1–4 (P < 0.05). The left and right height values of C7 were statistically different between groups 1–3 and groups 5–6 (P < 0.05) (Table 3, Figs. 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14).

Comparison of the NCS area

The area anatomical index of C2–C7 NCS was measured and it was found that the area value in groups 1–6 showed a gradual decrease with age. There was a maximum value in group 2, and the largest change was in groups 4–5. and the change range of NCS area value on the left and right sides of the same vertebral body of the same age was similar, and there was no statistical difference between the two sides (P > 0.05). In the comparison of different vertebral bodies of the same age, the NCS area values of the left and right sides of group 1 were statistically different between C4–C5 and C2 and C7 (P < 0.05). The values of the left and right NCS areas of group 1 were statistically different between C7 and C3 (P < 0.05). In the comparison of different ages of the same vertebral body, the NCS area values of C2–C7 were statistically different between groups 1–2 and groups 5–6 (P < 0.05) (Table 3, Figs. 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14).

Comparison of the NCS perimeter

The measurement of circumference anatomical indexes of C2–C7 NCS showed that the circumference value gradually decreased with age between 1–6 years old, and the value changed little. The variation of the circumference of the left and right sides of the same vertebral body at the same age was similar, and there was no significant difference between the two sides (P > 0.05). In the comparison of different vertebral bodies in the same age group, the circumference values of the left and right NCS sides of group 2 were statistically different between C5 and C2–C3 (P < 0.05). In the comparison of different ages of the same vertebral body, the left and right NCS perimeter values of C2 and C6 were statistically different between groups 1–2 and groups 5–6 (P < 0.05) (Table 3, Figs. 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14).

Discussion

Changes of cervical NCS with age in children

The spine is made up of bone and soft tissues that provide a range of motion and mechanical support for the body and protection of the central nervous system [7]. The spinal segment consists of vertebral bodies and vertebral arches, and in childhood, the NCS of the neural arch connects the incompletely ossified vertebral bodies to the vertebral arches. Studies [5] have shown that the growth of NCS can be divided into five stages, and NCS closes in a specific order on the spine, first occurring in the cervical spine region and closing at about 6 years old. It then occurred in the lumbar region, where closure was completed around the age of 12. The thoracic region closed the latest, around the age of 14. It has also been found that unclosed NCS can still be observed on the thoracic spine in adults [8].

This study found that the transverse diameter and circumference of NCS on the left and right sides of C2–C7 in children aged 1–6 years gradually decreased with age. The area had a maximum value when it was more than 2 years old. NCS gradually narrowed in the transverse direction, which was consistent with previous research results. Knutsson [9] and Schmorl, Junghaus [8] also believed that with age, NCS gradually began to ossify into bone, resulting in a general decrease in various anatomical indicators. The values of sagittal diameter and height showed a slight increase trend overall. NCS was gradually elongated longitudinally, and it was initially speculated that NCS first ossified from the center and then ossified around NCS. Yamazaki et al. [10] believed that this may be due to the irregular shape of cartilage ossification, which is consistent with the ossification pattern of interblock cartilage on the anterior arch and the intervertebral cartilage ossification pattern of the axial dentition. In the measurement of NCS cross diameter and sagittal diameter, it was found that the NCS cross diameter and sagittal diameter gradually changed with age. The values were similar in the age group of 5–6 years old, indicating that NCS may close at about 6 years old. This was consistent with the findings of Rajwani et al. [5]. There were no statistical differences in the left and right anatomical indexes of each cervical vertebrae segment, and the numerical changes were small, reflecting that the ossification process of NCS on both sides was consistent, which was consistent with Adib [11] and other studies.

Morphological changes of NCS in various segments of the cervical spine in children

At present, scholars at home and abroad have gradually paid attention to the law of growth and development of children's spinal ossification centers, and more and more scholars have paid attention to the fragility and importance of children's spinal growth. The cervical spine is one of the most vulnerable areas of the spine, bearing the weight of the head and in close contact with the central nervous system, making it susceptible to greater damage [12]. Therefore, studies have been conducted on the anatomical characteristics of the morphological development of the ossification center and cartilage of the cervical spine in children of different ages and the mechanical properties that maintain their stability during growth have gradually increased. But the differences between the morphological characteristics and positional anatomical features of NCS in each segment of the cervical spine have been relatively few studies [13]. Since cartilage structures such as the NCS of each cervical spine jointly promote the growth of vertebral arches and spinal canals [14], it is particularly important to understand the correlation and difference in the structure of each cervical vertebra. This provides timely theoretical support for understanding the abnormal growth and development of congenital cervical spine deformity and vertebral ossification center and cartilage [15].

This study found that as the transverse diameter of the descending NCS of the vertebral body gradually increased between C2–C7. During the age of 1–3 years old, the transverse diameter of C7 NCS was greater than the above cervical vertebrae segment, the change of NCS transverse diameter tended to be gentle at the age of 4–6 years old. So it was initially speculated that the development of NCS during the period of 1–3 years was large, and the growth rate of NCS in the stage of 4–6 years old with the descent of cervical spine was slow. Both sagittal diameter and circumference had large values in the middle cervical segment, and the area had smaller values in the middle cervical segment, which was inferred to indicate that the ossification process of the intermediate cervical segment progressed rapidly. These inferences are consistent with the observations of normal pediatric cervical spine imaging data by Vital [8]. The graph analysis further showed that the ossification process of NCS was obvious with age, and there were obvious differences between C2 and other cervical segments. Through the measurement of C7 NCS occupies a larger area, through imaging observation and measurement of vertebral body diameter, it can be seen that the C7 structure is similar to the thoracic vertebrae and larger than other cervical vertebral segments. This result shows that NCS in C7 segment, the anatomical structure is more similar to the thoracic NCS, which is consistent with the view of Madura et al. [16].

Deficiencies in basic research and clinical application of cervical NCS in children

The incomplete development of the cervical NCS in children can lead to corresponding injuries to the cervical spine, such as hypoplasia and abnormal ossification of the cervical vertebrae leading to insufficient cervical spine support [17]. Zhang [18] and others have found that impaired growth processes of the NCS can lead to scoliosis, and traumatic rupture of the cartilage of the NCS can occur in abused children [19].While most of these disorders may involve the NCS in the thoracic and lumbar spine, NCS injuries in the cervical spine can also lead to serious spinal disorders in children, and timely detection and treatment of cervical spine developmental disorders can have a significant impact on children's growth. Currently, studies on NCS imaging and NCS growth and development are increasingly being used to determine whether spinal growth and development are complete and to estimate bone age. Studies on the age of NCS closure, the mode of closure, and the relationship with developmental spinal disorders have not been clearly defined [6].

At present, the research on cervical vertebral cartilage by scholars at home and abroad focuses on the morphologic development of cervical vertebral cartilage in the fetal period or the diagnosis and treatment of cervical vertebral cartilage injury in adults, and there are fewer systematic researches on the regularity of cervical vertebral cartilage growth and development in childhood, which ignores this important stage of cervical vertebrae development in childhood. At present, the basic research on cervical NCS in children is still insufficient, mostly staying in the laboratory stage, and insufficiently combined with the clinical diseases of cervical spine injury in children. In this study, the data of 160 children aged 1–6 years were measured and analyzed according to the characteristics of cartilage closure, but there are still shortcomings, and we will further expand the sample size and conduct in-depth exploration by gender in the future. We will continue to explore the help of NCS development and ossification in maintaining normal cervical spine structure and explaining the mechanisms of cervical spine injury in children.

Conclusions

In this study, we measured and analyzed multiple anatomical indices of C2–C7 NCS in children aged 1–6 years, and found that the anatomical indices of cervical spine NCS in children were different between different age groups of the same vertebrae and between different cervical segments of the same age group, and that there was a clear pattern of developmental characteristics. This study provides basic data on the developmental characteristics and patterns of cervical NCS in children and is expected to provide a theoretical basis for analyzing its evolutionary patterns and effects on cervical spine developmental disorders in children.

Availability of data and materials

The datasets generated or analyzed during the current study are not publicly available due but are available from the corresponding author on reasonable request.

Abbreviations

NCS:

Neurocentral synchondrosis

CT:

Computed tomography

DICOM:

Digital Imaging and Communications in Medicine

Mimics:

Materialise’s interaticve medical image control system

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Acknowledgements

Heartfelt thanks to professor Shaojie Zhang, associate professor Xing Wang, teacher Ruifen Sun, teacher Xiaoyan Ren, teacher Kun Li for their guidance of the paper and the help provided by the Imaging Center of the provincial tertiary hospitals.

Funding

This work was supported by the National Natural Science Foundation of China (81660358); the Inner Mongolia Autonomous Region Health Science and Technology Program (202201219); the Department of Education's Science and Technology Leading Talents and Innovation Team Building Project (NMGIRT2307); the Youth Leader Team Project (QNLC-2020025); the Key project of Inner Mongolia Medical University (YKD2022ZD007).

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  1. Yuying Yi and Ziyu Li contributed equally to this work and share the first authorship.

Authors and Affiliations

  1. Graduate School, Inner Mongolia Medical University, Hohhot, 010110, Inner Mongolia, China

    Yuying Yi, Ziyu Li, Zhaozheng Yin & Fengzhen Zhang

  2. Imaging Center, Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia, China

    Ruifen Sun

  3. Department of Human Anatomy, School of Basic Medical Sciences, Inner Mongolia Medical University, Hohhot, 010110, Inner Mongolia, China

    Xing Wang, Kun Li & Shaojie Zhang

  4. Inner Mongolia Medical University Digital Medical Center, Inner Mongolia Medical University, Hohhot, 010110, Inner Mongolia, China

    Xing Wang, Kun Li & Shaojie Zhang

  5. Department of Endocrinology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, Inner Mongolia, China

    Xiaoyan Ren

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Contributions

YY and ZY wrote the main manuscript text; YY, ZY, FZ and ZZ prepared figures and Tables. All authors reviewed the manuscript. All authors read and approved the fnal manuscript.

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Correspondence to Shaojie Zhang or Xiaoyan Ren.

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Yi, Y., Li, Z., Sun, R. et al. Digital anatomical features of morphological development in C2–C7 neurocentral synchondrosis in children aged 1–6 years: a retrospective study of CT images. Eur J Med Res 29, 424 (2024). https://doi.org/10.1186/s40001-024-02020-1

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European Journal of Medical Research

ISSN: 2047-783X

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