• Yuwang Du, Weiyou Chen, Hongyuan Xu, Xiao Liang, Chongyang Wang, Hongyu Qin, and Hua Jiang.
• Department of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, PR China.
• World Neurosurg. 2024 Oct 1; 190: e496e503e496-e503.

ObjectiveTo investigate the effect of age and sex on odontoid parameters and their relationships with cervical sagittal alignment in children.MethodsA total of 155 Chinese children without cervical symptoms were divided into groups by age: 3-12 years (87 participants), 13-18 years (68 participants), and sex: male (91 participants) and female (64 participants). Lateral plain radiographs of the whole spine were analyzed for (1) odontoid parameters: odontoid incidence (OI), odontoid tilt, and C2 slope (C2S); and (2) cervical sagittal parameters: C0-2, C2-3, C2-4, C2-5, C2-6, and C2-7 angles (cervical lordosis [CL]), T1 slope (T1S), and T1S minus CL (T1S-CL). Student's t-tests, linear regression analyses, and Pearson's correlation coefficient analyses were performed.ResultsOI showed a significant difference between the 3-12 and 13-18 year groups (13.35°±4.32° vs. 17.21°±4.26°, P<0.001), and significant differences were also observed in odontoid tilt (P=0.001) and C2S (P<0.001) between different sexes. Positive correlations were found between age and OI in the 3-12 and 13-18 year groups (adjusted R2=0.104 and 0.048, respectively). OI and C2S were positively correlated with the C0-2 angle in all age and sex groups.ConclusionsAge emerged as a critical determinant of OI, which increased with age among pediatric populations. Clinicians should carefully consider the disparity in OI during the assessment and restoration of cervical sagittal balance in children.Copyright © 2024 Elsevier Inc. All rights reserved.

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