Clinical significance of imaging findings for atlantoaxial rotatory subluxation in children

Background/aim: This study evaluated the usefulness of measuring the atlantodental interval (ADI) and lateral atlantodental spaces (LADSs) by retrospectively analyzing the imaging data of children of various ages with and without atlantoaxial rotatory subluxation (AARS). Materials and methods: The data of 495 children who underwent cranial computed tomography were collected. Among these children, 255 children were clinically diagnosed with AARS while 240 children were not. ADI and LADS values were measured. Results: The difference in mean ADI between children with and without AARS in all age groups was statistically significant (t-test, all P < 0.05). In children without AARS, the 95% reference range for ADI was <3.2 mm. The difference in the variance of bilateral lateral atlantodental spaces (VBLADSs) between children with and without AARS in all age groups was statistically significant (rank-sum test, all P < 0.05), with a 95% reference range of 0–2.20 mm (D-test). Conclusion: The ADI is a well-known and frequently used parameter and is not new, but there is little research about this in China and here we confirm its application in Chinese children. The LADS is not a frequently used parameter, but it does not significantly differ. The VBLADS parameter is new and significant in this manuscript. We concluded that VBLADSs of >2.2 mm are useful indicators for the diagnosis of AARS in patients ≤14 years old. Finally, it can be concluded that ADI of ≥3.2 mm and VBLADS of >2.2 mm are useful indicators for the diagnosis of AARS in patients ≤14 years old. Widened LADSs would not be helpful in the diagnosis of AARS in children.