Radiographic observation of cervical immature epiphyseal ring 

Xie Siyuan, Lin Yuanxun, Zhang Yunaolong, Feng Ziyu, Li Yikai

Chinese Journal of Clinical Anatomy ›› 2025, Vol. 43 ›› Issue (1) : 26-30.

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Chinese Journal of Clinical Anatomy ›› 2025, Vol. 43 ›› Issue (1) : 26-30. DOI: 10.13418/j.issn.1001-165x.2025.1.05

Radiographic observation of cervical immature epiphyseal ring 

  • Xie Siyuan1, Lin Yuanxun1, Zhang Yunaolong1, Feng Ziyu1, Li Yikai1,2*
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Abstract

Objective    To investigate the normal developmental process of human cervical epiphyseal ring, so as to provide  basis for the diagnosis of disease and the determination of treatment plan. Methods   Two hundred and fifty patients (98 females and 152 males) who attended Nanfang Hospital of Southern Medical University to receive cervical X-ray lateral radiographs from January 2015 to December 2023 were retrospectively selected. The anterior and posterior epiphyseal rings below C2 to C7 were divided into four stages according to development stage: cartilage stage, ossification stage, fusion stage, and maturity stage. The height, length, distance from anterior/posterior margin of vertebral body (AP distance), and distance from the inferior margin of vertebral body (CC distance) of epiphyseal rings in the ossification stage were measured, and the correlation between these parameters and age was analyzed. Results    The ossification of epiphyseal ring first occurred on a 3-year-old child. All epiphyseal rings began to ossify in children over 15 years of age. The anterior side below C7 was the earliest to begin ossification, and anterior epiphyseal ring usually ossified earlier than posterior side, but posterior epiphyseal ring fused to vertebral body earlier. In the 25-year age group, 20 % of epiphyseal rings were still not completely fused to vertebral body. The mean height of epiphyseal rings during ossification stage was (0.7±0.3) mm, the mean length was (2.8±1.6) mm, the mean AP distance was (1.3±0.6) mm, and the mean CC distance was (0.4±0.2) mm. In 92 % of epiphyseal rings, the AP distance was not greater than 2.0 mm, and in 99 % of epiphyseal rings, the CC distance was not greater than 1.0 mm. There was no significant correlation between any of the parameters and age.    Conclusions    In this study, the normal developmental process of cervical epiphyseal rings in children in China was derived from the observation of cervical X-ray lateral radiographs, which is helpful for the assessment of individual development in clinical work and guiding the diagnosis and treatment of diseases.

Key words

Pediatric /   /   / Cervical spine /   /   / Epiphyseal ring

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Xie Siyuan, Lin Yuanxun, Zhang Yunaolong, Feng Ziyu, Li Yikai. Radiographic observation of cervical immature epiphyseal ring [J]. Chinese Journal of Clinical Anatomy. 2025, 43(1): 26-30 https://doi.org/10.13418/j.issn.1001-165x.2025.1.05

References

[1]  Edelson JG, Nathan H. Stages in the natural history of the vertebral end-plates[J]. Spine, 1988, 13(1): 21-26. DOI: 10.1097/00007632-1988010 00-00006.
[2] Cattell HS, Filtzer DL. Pseudosubluxation and other normal variations in the cervical spine in children. A study of one hundred and sixty children[J]. J Bone Joint Surg Am, 1965, 47(7): 1295-1309. DOI: 10.2106/00004623-196547070-00001.
[3]  Cramer GD, Darby SA. Clinical anatomy of the spine, spinal cord, and ANS[M]. 3rd ed. St. Louis, Missouri: Mosby, 2017.
[4]  O'neal ML. The pediatric spine: anatomical and dynamic considerations preceding manipulation[J]. Compr Ther, 2003, 29(2-3): 124-129. DOI: 10.1007/s12019-003-0016-5.
[5]  Vohra S, Johnston BC, Cramer K, et al. Adverse events associated with pediatric spinal manipulation: a systematic review[J]. Pediatrics, 2007, 119(1): e275-e283. DOI: 10.1542/peds.2006-1392.

[6] Uys A, Bernitz H, Pretorius S, et al. Age estimation from anterior cervical vertebral ring apophysis ossification in South Africans[J]. Int J Legal Med, 2019, 133(6): 1935-1948. DOI: 10.1007/s00414-019-02137 -7.

[7]  Woo TD, Tony G, Charran A, et al. Radiographic morphology of normal ring apophyses in the immature cervical spine[J]. Skeletal Radiol, 2018, 47(9): 1221-1228. DOI: 10.1007/s00256-018-2909-5.
[8]  Gray H, Standring S, Ellis H, et al. Gray’s anatomy: the anatomical basis of clinical practice[M]. 39th ed. Edinburgh ; New York: Elsevier Churchill Livingstone, 2005. 
[9]  Osenbach RK, Menezes AH. Pediatric spinal cord and vertebral column injury[J]. Neurosurgery, 1992,30(3):385-390. DOI: 10.1227/00006123- 199203000-00012.
[10]Lowrey JJ. Dislocated lumbar vertebral epiphysis in adolescent children. Report of three cases[J]. J Neurosurg, 1973, 38(2): 232-234. DOI: 10.3171/jns.1973.38.2.0232.
[11]Pouliquen JC, Kassis B, Glorion C, et al. Vertebral growth after thoracic or lumbar fracture of the spine in children[J]. J Pediatr Orthop, 1997, 17(1): 115-120. DOI: 10.1097/01241398-199701000-00024
[12]Albert M, Mulhern D, Torpey MA, et al. Age estimation using thoracic and first two lumbar vertebral ring epiphyseal union[J]. J Forensic Sci, 2010, 55(2): 287-294. DOI: 10.1111/j.1556-4029.2009.01307.x.
[13]Sanders JO, Karbach LE, Cai X, et al. Height and extremity-length prediction for healthy Children using age-based versus peak height velocity timing-based multipliers[J]. J Bone Joint Surg Am, 2021, 103(4): 335-342. DOI: 10.2106/JBJS.20.00040.
[14]Costa L, de Reuver S, Kan L, et al. Ossification and fusion of the vertebral ring apophysis as an important part of spinal maturation[J]. J Clin Med, 2021, 10(15): 3217. DOI: 10.3390/jcm10153217.
[15]Sairyo K, Goel VK, Masuda A, et al. Three dimensional finite element analysis of the pediatric lumbar spine. Part II: biomechanical change as the initiating factor for pediatric isthmic spondylolisthesis at the growth plate[J]. Eur Spine J, 2006, 15(6): 930-935.DOI: 10.1007/s00586-005-1033-0.

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