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Neuroradiology Case of the Week

Case 102

Peter Takeyama, MD and PL Westesson, MD, PhD, DDS

Clinical Presentation: A 6-year-old female status post-fall and trauma to the cervical spine. There is a question of a prior cervical spine fracture at an unknown level. No pertinent comparison exams were available.

Radiological Findings: There is an “extra suture” in the midline of the anterior ring of the C1 vertebra (arrow) which demonstrates well corticated non-displaced margins. There are “true sutures” or synchondroses bilaterally in the anterior ring of the C1 vertebra. No soft tissue edema seen. These findings are consistent with an old non-displaced fracture of the midline of C1 anterior ring.

Diagnosis: Old midline fracture of the C1 ring

Discussion: Cervical spine trauma in the pediatric patient can be tricky but knowing the normal development and synchondroses location of the cervical spine can be extremely helpful in the evaluation process. The C1 vertebra is formed from three primary ossification centers - the anterior arch and the two neural arches. The anterior arch ossifies by one year of age. The neural arches (when fused forms the posterior ring) appear around the 7th fetal week and fuses with the anterior arch by age 7.

References:

1. Lustrin ES. Karakas SP. Ortiz AO. Cinnamon J. Castillo M. Vaheesan K. Brown JH. Diamond AS. Black K. Singh S. Pediatric cervical spine: normal anatomy, variants, and trauma. Radiographics. 23(3):539-60, 2003 May-Jun.