Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Mar 11:5:104233.
doi: 10.1016/j.bas.2025.104233. eCollection 2025.

Sagittal changes in the dens significantly slowed after 12 years of age

Zhi-Jun Sha  1 , Sheng-Yu Fu  2 , Zhao-Rui Wang  1 , Hai-Feng Hang  3 , Ai-Bing Huang  1
Affiliations

Sagittal changes in the dens significantly slowed after 12 years of age

Zhi-Jun Sha et al. Brain Spine. .

Abstract

Introduction: The odontoid process is an important component of the upper cervical, and the process of ossification for odontoid does not cease completely until skeletal maturity.

Research question: The aim of the study was to obtain the inclination parameters of the dens in many healthy children and to analyze the trends and variations in the inclination of the dens.

Material and methods: All the CT data obtained from our hospital was reviewed for next measurement. Posterior edge of odontoid angle (PEOA), anterior edge of odontoid angle (AEOA), odontoid retroflection angle (ORA), posterior dens angulation angle (PDAA), screw insertion angle (SIA), and pB-C2 line were measured and analyzed.

Results: A total of 219 patients were divided into 6 groups based on age at an interval of 3 years. The mean values of PEOA and PDAA dropped dramatically with age up to the ten to twelve-year group and then decreased slightly until 18 years old. Moreover, the AEOA and ORA declined gradually from birth to adulthood. These parameters were statistical significance within different age groups. However, the SIA was largely unchanged from birth to 18 years old and appeared to be independent of age. In contrast, the PB-C2 line has a distinguish distribution, with an increase up to the nine to twelve-year age group and then gradually decreased until 18 years old.

Discussion and conclusion: The inclination of dens was constantly changing during pediatric growth, but the trends were different. These developmental changes slow down significantly after the age of 12 years.

Keywords: Cervical spine; Growth; Inclination; Odontoid; Pediatric.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
A, Posterior edge of the odontoid angle (PEOA): the angle between the posterior edge of the odontoid and the inferior endplate of C2; B, Anterior edge of the odontoid angle (AEOA): the angle between the anterior edge of the odontoid and the inferior endplate of C2; C, Odontoid retroflection angle (ORA); D, Posterior dens angulation angle (PDAA): the angle between the posterior edge of the odontoid and the C2 vertebrae; E, Screw insertion angle (SIA): the angle between the line from the superior posterior aspect of the odontoid to the inferior anterior aspect of C2 and the inferior endplate of C2; F, Perpendicular basion-C2 line (pB-C2): a line drawn through the posterior aspect of the odontoid perpendicular to a second line from the basion to the inferior posterior aspect of the C2 vertebra.
Fig. 2
Fig. 2
Left, PEOA: posterior edge of the odontoid angle; AEOA: anterior edge of the odontoid angle; ORA: odontoid retroflection angle; PDAA: posterior dens angulation angle; SIA: screw insertion angle. Right, pB-C2: perpendicular basion-C2 line.
See this image and copyright information in PMC

References

    1. Akobo S., Rizk E., Loukas M., Chapman J.R., Oskouian R.J., Tubbs R.S. The odontoid process: a comprehensive review of its anatomy, embryology, and variations. Childs Nerv. Syst. 2015;31(11):2025–2034. doi: 10.1007/s00381-015-2866-4. Epub 2015/08/09. PubMed PMID: 26254085. - DOI - PubMed
    1. Baaghtmyr El-Hawary. In: The Growing Spine. third ed. Alain Dimeglio F.C., Bonnel François, Parent Stefan, editors. Springer Nature; Switzerland: 2022. p. 58.
    1. Bapuraj J.R., Bruzek A.K., Tarpeh J.K., Pelissier L., Garton H.J.L., Anderson R.C.E., et al. Morphometric changes at the craniocervical junction during childhood. J. Neurosurg. Pediatr. 2019:1–9. doi: 10.3171/2019.4.PEDS1968. Epub 2019/06/22. PubMed PMID: 31226679. - DOI - PubMed
    1. Chauhan A.K., Chandra P.S., Goyal N., Chowdhury M.R., Banerjee J., Tripathi M., et al. Weak ligaments and sloping joints: a new hypothesis for development of congenital atlantoaxial dislocation and basilar invagination. Neurospine. 2020;17(4):843–856. doi: 10.14245/ns.2040434.217. Epub 2021/01/07. PubMed PMID: 33401861; PubMed Central PMCID: PMCPMC7788422. - DOI - PMC - PubMed
    1. Chun D.H., Yoon D.H., Kim K.N., Yi S., Shin D.A., Ha Y. Biomechanical Comparison of four different atlantoaxial posterior fixation constructs in adults: a finite element study. Spine (Phila Pa 1976) 2018;43(15) doi: 10.1097/brs.0000000000002584. E891-e7. Epub 2018/02/21. PubMed PMID: 29462065. - DOI - PubMed

LinkOut - more resources