• Jiarui Chen, Tuo Liang, Yajie Hu, Youliang Ma, Shengsheng Huang, Liyi Chen, Jie Jiang, Hao Li, Tianyou Chen, Jiemei Cen, Chong Liu, and Xinli Zhan.
• Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China.
• Eur Spine J. 2022 May 1; 31 (5): 1241-1250.

BackgroundThe growth and development of the atlas in children has not been studied to date using a large sample size.ObjectiveTo study whether a 3.5-mm screw is suitable for the atlas in children, to explore the anatomical size and development of the atlas in 0-14-year-old children, and to provide morphological basis for lateral mass screw internal fixation.MethodsA Computed Tomography (CT) morphometric analysis was performed on 420 pediatric atlases. In the atlas, D1, D2, D3, D4, and α of the atlas lateral mass were measured. Statistical analysis was performed using one-way ANOVA and Students' t test. The least square method was used for the regression analysis of the change trend in anatomical structure. The curve with the greatest goodness of fit was used as the anatomic trend regression curve.ResultsD1, D2, D3, and D4 generally showed an increasing trend with age. The ranges of averages of D1, D2, D3, D4, and α in 0-14 year-old children were as follows: 4.576-9.202 mm, 9.560-25.100 mm, 3.414-10.554 mm, 11.150-27.895, and 12.41°-20.97°, respectively. The trends of the fitting curves of L1 and L3 were power functions, and those of L2 and L4 were logarithmic curves.ConclusionsCT examination could help in preoperative decision-making, and 3.5-mm screw was found to be suitable for lateral mass screw internal fixation in children aging 2 years and older. D1-D4 increased with age. This provided a certain reference to perform posterior atlantoaxial fusion in children and is of great significance to design posterior atlantoaxial screw in children.© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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