What Is Normal, Anyway? Dr. Anderson Looks at Cervical Spine Growth in Children and Adolescents

Sep. 15, 2016

spine growthAnyone who has had the pleasure of seeing a child develop can marvel at how differently the various parts of the body grow. For example, most head growth takes place within the first few years of life. On the other hand, anyone who has had to purchase shoes for a teenager can attest to the rapid growth of the feet during adolescence.

The miracles of growth and development are likely what attract many doctors to specialize in the care of children and teenagers. Yet those miracles also come with unique challenges: Because children are not simply miniature adults, their physical characteristics are often quite different.

Doctors need to take these differences into account when providing treatment to young people. Nowhere is this more evident than when they need to perform a surgical procedure.

Columbia University neurosurgeons know that this applies particularly to their field. They see a large number of abnormalities related to the spine. However, rapid advances in the field of neurosurgery have demonstrated that there is still much to learn about normal child anatomy. So how do they compare these abnormalities with a normal spine if there isn’t a full picture of what is normal?

That’s where pediatric neurosurgeon Dr. Richard C.E. Anderson from the The Spine Hospital at the Neurological Institute of New York comes in. Together with his colleagues*, he recently lent his expertise to a study, published in the Journal of Neurosurgery: Pediatrics, analyzing normal spine growth in children ages 1 to 18.

Their study focused on the cervical spine. This is the uppermost area of the spinal column, on which the skull rests. It consists of seven bones, or vertebrae, connected by softer tissues, which form the intervertebral discs. In the center of the spine is a hollow cavity known as the spinal canal. This houses and protects the spinal cord as it exits the brain.

The group looked at 12 to 15 normal children at each age, from 1 to 17. Each of the children had undergone a single CT scan series as part of their medical treatment. They took 23 different measurements of the children’s cervical spines—the most comprehensive study of its type—and calculated normal values from that data.

One noteworthy result came in the form of a difference between the sexes. Girls’ spines normally stopped growing around age 14, whereas boys’ spines continued to grow until age 18.

The researchers also found that three quarters of the lengthening of the spine occurred in the bottom five (lumbar) vertebrae . Finally, the spinal canal—that space in the middle of the vertebrae containing the spinal cord—grew proportionally less than the bony spine itself.

In their discussion, the authors point out the importance of their measurements. For example, it is known that the cervical spine reaches biomechanical maturity around 9 years of age; it was assumed that the cervical spine reached structural maturity around that time as well. Thanks to this study, however, we now know that it continues to grow structurally through much of the teenage years.

Also, the spinal canal—that cavity that contains the spinal cord—was thought to continue to grow significantly during childhood. The authors found that most of the growth of this space is complete by age 4.

Thanks to this study, neurosurgeons now have the knowledge that will help them more accurately compare abnormalities in the spine with a more fully formed understanding of what is normal. It will also help them understand effects of surgical treatments including instrumentation and fusion over time. And with this new information they can fine-tune their diagnoses as well as their treatments.

Learn more about Dr. Anderson on his bio page here.

Read the Journal of Neurosurgery: Pediatrics article excerpt here.

*Full list of authors: Kyle T. Johnson, B.S., Wajd N. Al-Holou, M.D., Richard C. E. Anderson, M.D., Thomas J. Wilson, M.D., Tejas Karnati, B.S., Mohammed Ibrahim, M.D., Hugh J. L. Garton, M.D., M.H.Sc. and Cormac O. Maher, M.D.

Click here to return to The Spine Hospital at The Neurological Institute of New York.

Image credit: ©DayronV/pixabay

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