Changes in Cervical Lordosis and Cervicovertebral Morphology in Different Ages with the Possibility of Estimating Skeletal Maturity

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1 662 Srp Arh Celok Lek Nov-Dec;143(11-12): DOI: /SARH L ОРИГИНАЛНИ РАД / ORIGINAL ARTICLE UDC: Chnges in Cervicl Lordosis nd Cervicovertebrl Morphology in Different Ages with the Possibility of Estimting Skeletl Mturity Emir Lzić, Brnislv Glišić, Zorn Stmenković, Nend Nedeljković University of Belgrde, Fculty of Dentl Medicine, Deprtment of Orthodontics, Belgrde, Serbi SUMMARY Introduction During growth, proportions of crniofcil nd cervicl structures re chnged. Crniofcil nd cervicovertebrl structures re morphologiclly nd functionlly connected, but their ech other s influence is still unknown. Objective The im of this study ws to determine the chnges in cervicl lordosis nd cervicovertebrl morphology in different ge periods nd the possibility of estimting skeletl mturity, bsed on the percentge of nterior cervicl vertebre body height sum in the totl nterior C2 C5 height. Methods The study included lterl rdiogrphs of 120 ptients of both sexes, divided into three different ge groups: eight, nd yers of ge. Five crniofcil nd 15 cervicl prmeters were mesured nd nlyzed. Results The results showed significnt correltion between cervicl lordosis ngle nd ge, gender, nterior nd posterior body height of C3, C4, C5, nterior C4 C5 nd posterior C2 C3, C3 C4, C4 C5 intervertebrl spce, nterior body height of C2 C5. Overll vlues of ll cervicl body heights were more present in the totl height of the spine in femles, while ll intervertebrl spces were more present in mles. The percentge of nterior nd posterior C2, C3, C4, C5 body height sum compred to totl C2 C5 height increses with ge. Conclusion The cervicl lordosis becomes more curved nd vertebrl bodies occupy more spce in femles, while intervertebrl spces occupy more in mles. Skeletl mturity could be estimted following vertebrl percentge distribution in the totl nterior C2 C5 prt. Keywords: spinl curvtures; lordosis; growth; mturity Correspondence to: Nend NEDELJKOVIĆ Deprtment of Orthodontics Fculty of Dentl Medicine University of Belgrde Gston Grvije Belgrde Serbi nend.nedeljkovic@stomf.bg.c.rs INTRODUCTION During prentl nd postntl period proportions of cervicl structures chnge [1, 2]. Cervicovertebrl morphology is influenced by fctors such s ge [3], gender [3-7], ethnic origin [5, 8] nd crniofcil morphology [6, 7, 9]. The chnge in cervicovertebrl morphology is process lsting from birth to full mturity, pssing through ll stges of skeletl development [1]. Every stge cn be seen on lterl cephlogrm which ws used to ssess skeletl mturity using the cervicl vertebrl mturtion (CVM) method [10, 11, 12]. However, vlidity, relibility nd reproducibility of the CVM method were nlyzed in severl studies. It ws suggested tht this method ws subjective nd tht it should be used with some other prmeters tht estimte skeletl mturity [13-18]. Cervicl curve begins to form during fetl development, but it does not ssume its nturl form until fter birth. It chnges when it begins to ber the weight of the hed. Also, lordotic curve results prtly from difference in the nterior nd posterior intervertebrl spce heights [19]. OBJECTIVE Our im ws to determine the chnges in cervicl lordosis in different ge groups, to compre the differences in cervicovertebrl morphology between genders, nd to determine the possibility of estimting skeletl mturity bsed on the percentge of nterior cervicl vertebre C2 C5 body height sum in comprison to the totl nterior height of tht prt of the cervicl spine. METHODS The study included lterl cephlogrms of 120 (71 femle, 49 mle) ptients treted t the Clinic of Orthodontics, School of Dentl Medicine, University of Belgrde. The Ethicl Committee of the School of Dentl Medicine, University of Belgrde, pproved this reserch (No. 36/ ). The inclusion criteri were white subjects of Serbin popultion of both sexes with the visibility of the C1 C5 cervicl vertebre. Totl smple ws divided into three different ge groups: I (eight-yer-olds pre-puberty), II (12- nd 13-yer-olds ccelerted period of growth) nd III (17- nd 18-yer-olds finl phse of growth); ech group consisted of 40 subjects. None of the subjects hd history of previous orthodontic tretment, crniofcil nd cervicl vertebr nomlies, trum, or systemic muscle or temporomndibulr joint disorders. Lterl cephlogrms were mde using stndrdized technique on ProMx device

2 Srp Arh Celok Lek Nov-Dec;143(11-12): Sttisticl nlysis All sttisticl nlyses were performed in IBM SPSS Sttistics for Windows Softwre (Version 20.0, Armonk, NY, USA). The results were presented s frequency, percent nd men ± SD. The nlysis of vrince nd Kruskl Wllis test were used to compre three groups while t-test nd Mnn Whitney U-test were used to compre two groups of ptients. Bonferroni correction ws used for multiple comprisons. Person correltion ws performed to ssess ssocitions of OPT/CVT ngle nd other vribles. All p-vlues less thn 0.05 were considered significnt. RESULTS Figure 1. Cephlometric points, ngulr nd liner mesurements used for lterl cephlogrm nlysis Ver true verticl line projected on the film; Hor true horizontl line drwn by constructing line perpendiculr to the true verticl line; cv2sp posterosuperior points of C2 vertebrl bodies; cv2ip postero-inferior points of C2 vertebrl bodies; OPT tngent of odontogenic processus through cv2sp nd cv2ip; CVT tngent through cv2sp nd cv4ip (enlrgement fctor 10%), Plnmec, Helsinki, Finlnd. The ptients were in stnding position, with the hed in the nturl hed position, nd with the teeth in occlusion [20]. All rdiogrphs were trced mnully, using cette pper, nd ll mesurements were tken by single observer (E.L.). On ech rdiogrph cervicl prmeters (Figure 1, Tble 1) were mesured nd used to ssess cervicovertebrl morphology in different ge groups nd genders. Totl smple consisted of 71 femle nd 49 mle ptients divided into three different ge groups. This ge distribution ws mde in order to see the cervicovertebrl morphology in different ge periods. The results showed the trend of OPT/CVT ngle increse from group I to group III nd sttisticlly higher vlue in femle ptients. A comprison between ge groups showed sttisticlly significnt increse in older groups compred to younger ones (Tble 2). The prmeters with sttisticlly significnt correltion with OPT/CVT ngle re presented in Tble 3. Correltion coefficients re presented in n intervl from the smllest to the lrgest nd showed wek to moderte correltion. Tbles 4 nd 5 show vlues nd comprisons between ge group I compred to ge group II, nd ge group II com- Tble 1. Description of cervicl prmeters (1) OPT/CVT ( ) Angle of cervicl curvture lordosis; down open ngle between OPT: tngent of odontogenic processus through cv2sp nd cv2ip nd CVT: tngent through cv2sp nd cv4ip (2 5) ABH C2 C5 (mm) Anterior height of the cervicl vertebr bodies the distnce between ntero-superior nd ntero-inferior points of C2 C5 vertebrl bodies (6 9) PBH C2 C5 (mm) Posterior height of the cervicl vertebr bodies the distnce between postero-superior nd postero-inferior points of C2 C5 vertebrl bodies (10 12) AIS C2 C5 (mm) Anterior intervertebrl spce of the cervicl vertebre the nterior distnce between C2 C5 bodies (13 15) PIS C2 C5 (mm) Posterior intervertebrl spce of the cervicl vertebre the posterior distnce between C2 C5 bodies %ABHC/AH C2 C5 Percentge of nterior body heights of C2, C3, C4 nd C5 in totl nterior height of the C2 C5 prt %PBHC/PH C2 C5 Percentge of posterior body heights of C2, C3, C4 nd C5 in totl posterior height of the C2 C5 prt %AIS C2 C3/AH C2 C5 Percentge of nterior intervertebrl spce height C2 C3, C3 C4, C4 C5 in totl nterior height of the C2 C5 prt %PIS C2 C3/PH C2 C5 Percentge of posterior intervertebrl spce height C2 C3, C3 C4, C4 C5 in totl posterior height of the C2 C5 prt % ABH C/AH C2 C5 Percentge of nterior C2, C3, C4, C5 body heights sum in totl nterior height of the C2 C5 prt % PBH C/PH C2 C5 Percentge of posterior C2, C3, C4, C5 body heights sum in totl posterior height of the C2 C5 prt % AIS/AH C2 C5 Percentge of nterior intervertebrl spce height sum in totl nterior height of the C2 C5 prt % PIS/PH C2 C5 Percentge of posterior intervertebrl spce height sum in totl posterior height of the C2 C5 prt Tble 2. Chnges of cervicl lordosis ngle ccording to ge nd gender Vrible OPT/CVT ( ) Overll I I vs II II II vs III III I vs III Totl (n=120) 4.03± ±3.14 * 4.63± ±3.33 ** Mle (n=49) b 3.02± ± ± ±3.65 Femle (n=71) b 4.73±2.70* 3.18±2.74 * 5.27±1.55* 5.83±2.84* ** ANOVA; b Student s t-test; * p<0.05; ** p<0.01 n number of ptients

3 664 Lzić E. et l. Chnges in Cervicl Lordosis nd Cervicovertebrl Morphology in Different Ages with the Possibility of Estimting Skeletl Mturity Tble 3. Correltion of cervicl lordosis ngle (OPT/CVT) with different prmeters Vrible R Gender 0.274** Age 0.326** ABH C3, C4, C ** 0.278** PBH C3, C4, C ** 0.255** AIS C4 C * PIS C2 C3, C3 C4, C4 C ** ** ABH C2 C ** % AH C/C2 C * % PH C/C2 C ** % AIS/C2 C * % PIS/C2 C ** R coefficient of correltion * p<0.05, ** p<0.01 pred to ge group III. Comprison between group I nd group III ws not described becuse of lrge ge difference nd expected sttisticl significnce. Sttisticlly significnt increse of nterior nd posterior C2, C3, C4 nd C5 body heights between ge groups is shown in Tble 4. All nterior intervertebrl spces were sttisticlly smller in group III compred to group II, while posterior intervertebrl spces were sttisticlly smller in group II compred to group I. Therefore, there ws generl trend of cervicl vertebre body growth from group I to group III nd decrese of the intervertebrl spce. There ws significnt increse of totl C2 C5 nterior nd posterior height. According to sex, overll liner vlues were greter in mles, except the vlues of the nterior body heights of the vertebre C3, C4 nd C5. Sttisticlly significnt difference between sexes ws found in nterior nd posterior body height of the vertebre C2 nd posterior intervertebrl spce C3 C4. The results showed tht the biggest prt of the cervicl spine C2 C5 ws vertebr C2, verge 44.12±2.09% of the nterior height nd 42.35±2.35% of the posterior height of the prt C2 C5. The rest ws eqully distributed with vertebre C3, C4, C5 t round 12.7% of the nterior height, nd round 15.3% of posterior height of the prt C2 C5. The trend of incresing nterior nd posterior C3, C4 nd C5 body distribution ws observed from group I to group III, while percentges of nterior nd posterior C2 body height, s well s nterior nd posterior height of ll the intervertebrl spces, were lower (Tble 5). Overll vlues of nterior nd posterior body height were more presented in the totl height of the spine in femles, but sttisticl significnces were found in nterior C4 nd C5 body height. The vlues of ll nterior nd posterior intervertebrl spces were more present in the totl height of the spine in mles, but sttisticl significnces were found in nterior C2 C3 nd C4 C5 intervertebrl spces. The percentge of nterior nd posterior C2, C3, C4 nd C5 body height sum compred to totl C2 C5 height showed the trend of incresing from group I to group III nd the percentge ws greter in femles from ll groups. Sttisticl significnce ws found in most prmeters of nterior prt of the spine (Tble 6). In order to lower the mrgin of error, repeted mesurements were tken during one week, by single observer (E.L.), on 20 rndomly selected rdiogrms. Inter-observer relibility ws mesured with inter-clss correltion coefficient. The coefficient ws high (ICC=0.986; p<0.001), which suggested high precision of mesurements nd low error. DISCUSSION Incompletely clrified link between crniofcil nd cervicl structures nd common questions bout the relibility of skeletl mturity estimtions using cervicl morphology chnges mkes the cervicl region still current field of reserch. Considering the visibility of C1 C5 vertebre in lterl cephlogrms, this study described the morphology of the stted cervicl segment nd cervicl lordosis (OPT/CVT). Some previous studies nlyzed the upper nd middle (OPT, CVT) segment [4, 7, 21], nd lower (EVT) segment of the cervicl column nd it ws found tht morphology chnges in upper nd middle segments were ffected by fcil development [6]. Age nd sex ply importnt roles in cervicl lordosis chnge during growth s studies conducted by Hellsing et l. [3] nd Nik nd Aciybr [7] hve shown, so our study included three ge groups of ptients in different stges of development in order to notice the differences in vlues of OPT/CVT ngle. Our results indicted trend of incresed ngle in femles with ge, while the ngle decresed fter 12 nd 13 yers of ge in mle ptients. Lower ngle ws found in mles, which indictes strighter spine. The positive correltion ws found between cervicl lordosis, nd ge nd sex (Tble 3).These results re in greement with previous studies of differences in spinl curvture between sexes [3, 6, 7], not confirmed by Tecco nd Fest [22]. Dos Sntos et l. [1] included Brzilin sixto 16-yer-old ptients nd nlyzed ngulr inclintion of cervicl vertebre (C1 C5) long the sgittl plne. They found opposite ngulr tendency of vertebre C2, C3 nd C4 during growth. The spine hs tendency for flexion in femles, but extension in mles. These findings mtch with the results of our study, but s consequence of differences in ge groups it ws not possible to determine the mgnitude of vritions between them. Dimensions of cervicl vertebre nd intervertebrl spces chnge during growth [1, 2, 12, 23, 24]. Generlly, in our study, the vlues of the vertebre body heights got higher with ge, while the spces between them becme smller (Tble 4). Anterior nd posterior C2 body height, posterior C3, C4 nd C5 body heights, nterior nd posterior C2 C3, C3 C4 nd C4 C5 intervertebrl spce heights were greter in mles, while the vlues of the nterior C3, C4 nd C5 body heights were greter in femles. At the ge of eight, the vlues of C2, C3, C4 nd C5 nterior nd posterior body heights nd posterior intervertebrl spce C2 C3 were greter in femles tht entered puberty erlier. At the ges of 12 nd 13, the vlues of nterior nd posterior C3 nd C4 body heights, nterior C5 body height, nd posterior intervertebrl spce C3 C4 nd C4 C5 were greter in femles, while t the ges of 17 nd 18, ll liner prmeters becme greter in doi: /SARH L

4 Srp Arh Celok Lek Nov-Dec;143(11-12): mles (they reched femles). The vlues of nterior nd posterior C3, C4, nd C5 body heights showed positive correltion between cervicl lordosis, while the vlues of nterior C4 C5 nd posterior C2 C3, C3 C4, C4 C5 intervertebrl spces showed negtive correltion (Tble 3). The tendency of greter cervicl dimensions in mles nd the fct tht mles hve longer spine thn femles ws noted in severl studies [5, 8]. On the other hnd, Byds et l. [23] study included 13- to 15-yer-old ptients nd found similr results in most prmeters for both sexes. Dos Sntos et l. [1] study showed tht nterior body height of the vertebr C2, nterior nd posterior body Tble 4. Chnges of cervicl liner prmeters ccording to ge nd gender Vrible (mm) Gender b Overll I vs II vs III Totl 31.94± ±2.58 *** 31.97±2.57 *** 35.56±2.79 ABH Mle 32.44± ±2.28 *** 32.38± 2.75 *** ±2.57 C2 Femle 31.60± ±2.60 ** 31.63±2.42 *** 34.36±2.26 Totl 28.76± ±2.35 *** 28.79±2.23 *** 31.58±2.78 PBH Mle 29.31± ±2.39 *** 29.07±2.60 *** 33.49±2.40 Femle 28.39± ±2.23 ** 28.55±1.90 ** 30.30±2.26 Totl 9.57± ±0.90 *** 9.18±1.63 *** 13.07±1.40 ABH Mle 9.56± ±0.77 *** 8.68±1.16 *** 13.71±1.21 C3 Femle 9.57± ±0.94 *** 9.58±1.87 *** 12.65±1.38 Totl 10.63± ±0.86 *** 10.47±1.47 *** 13.39±1.30 PBH Mle 10.86± ±0.65 *** 10.41±1.32 *** 14.17±1.40 Femle 10.48± ±0.97 *** 10.53±1.62 *** 12.87±0.95 Totl 9.26± ±0.78 *** 8.76±1.50 *** 12.55±1.24 ABH Mle 9.11± ±0.36 *** 8.22±1.00 *** 12.90±0.99 C4 Femle 9.35± ±0.91 *** 9.21±1.71 *** 12.31±1.35 Totl 10.55± ±0.94 *** 10.32±1.33 *** 13.46±1.30 PBH Mle 10.82± ±0.74 *** 10.46±1.42 *** 14.24±1.18 Femle 10.36± ±1.03 *** 10.20±1.28 *** 12.95±1.14 Totl 9.27± ±0.83 *** 8.63±1.42 *** 12.54±1.22 ABH Mle 9.17± ±0.41 *** 8.33±1.08 *** 12.89±1.05 C5 Femle 9.35± ±0.74 *** 9.07±1.56 *** 12.31±1.29 Totl 10.49± ±0.89 *** 10.19±1.23 *** 13.44±1.32 PBH Mle 10.71± ±0.86 *** 10.23±1.28 *** 14.24±1.18 Femle 10.34± ±0.87 *** 10.15±1.22 *** 12.91±1.15 Totl 4.18± ± ±1.22 *** 3.03±1.09 AIS Mle 4.64± ± ±0.88 *** 3.58±1.24 C2 C3 Femle 3.87± ± ±1.27 *** 2.67±0.81 Totl 2.84± ±0.86 * * 2.80± ±0.86 PIS Mle 2.94± ± ± ±0.89 Femle 2.77± ±0.92 ** 2.68± ±0.79 Totl 4.29± ± ±1.16 *** 3.01±1.03 AIS Mle 4.70± ± ±1.19 *** 3.51±1.21 C3 C4 Femle 4.00± ± ±1.05 *** 2.68±0.74 Totl 2.48± ±0.85 ** 2.26± ±0.91 PIS Mle 2.67± ±0.79 ** 2.26± ±1.07 Femle 2.35± ±0.84 * 2.27± ±0.74 Totl 3.88 ± ± ±1.04 *** 2.90±1.04 AIS Mle 4.40± ± ±0.67 *** 3.48±1.16 C4 C5 Femle 3.51± ± ±1.05 *** 2.51±0.74 Totl 2.44± ±0.78 *** 2.20± ±0.87 PIS Mle 2.51± ±0.93 ** 2.16± ±1.03 Femle 2.39± ±0.67 ** 2.23± ±0.75 Totl 72.44± ±4.63 *** 72.07±5.27 *** 82.66±6.08 AH Mle 74.08± ±4.62 *** 72.63±5.11 *** 87.42±3.68 C2 C5 Femle 71.30± ±4.64 *** 71.62±5.47 *** 79.48±5.24 Totl 68.19± ±3.81 *** 67.01±4.84 *** 78.48±6.55 PH Mle 69.81± ±3.35 *** 67.51±4.87 *** 83.50±4.78 Femle 67.07± ±3.98 *** 66.60±4.89 *** 75.13±5.36 ANOVA; b Student s t-test; Significnt gender difference p<0.05; Significnce level t * p<0.05, ** p<0.01, *** p<

5 666 Lzić E. et l. Chnges in Cervicl Lordosis nd Cervicovertebrl Morphology in Different Ages with the Possibility of Estimting Skeletl Mturity Tble 5. Percentge of nterior nd posterior cervicl vertebre body height nd intervertebrl spce compred to totl nterior nd posterior height of C2 C5 prt Vrible (%) Gender b Overll I vs II vs III Totl 44.21± ± ±1.88 ** 43.04±1.88 ABH Mle 43.88± ± ±1.73 * 42.71±1.83 C2 Femle 44.43± ±1.75 * 44.20± ±1.92 Totl 42.35± ± ±1.72 *** 40.26±1.73 PBH Mle 42.15± ± ±1.58 *** 40.10±1.55 Femle 42.50± ± ±1.87 *** 40.37±1.87 Totl 12.94± ±1.28 *** 12.69±1.79 *** 15.81±1.17 ABH Mle 12.58± ±1.01 *** 11.93±1.11 *** 15.68±1.18 C3 Femle 13.19± ±1.42 *** 13.32±2.01 *** 15.90±1.19 Totl 15.42± ±1.25 *** 15.59±1.53 *** 17.07±1.02 PBH Mle 15.35± ±1.12 *** 15.39±1.35 ** ±1.24 Femle 15.47± ±1.34 *** 15.75±1.67 ** 17.15±0.86 Totl 12.55± ±1.19 *** 12.12±1.58 *** 15.20±1.20 ABH Mle 12.05± ±0.59 ** 11.30±0.97 *** 14.78±1.25 C4 Femle 12.90± ±1.14 *** 12.79±1.68 *** 15.47±1.11 Totl 15.28± ±1.25 *** 15.37±1.40 *** 17.16±0.88 PBH Mle 15.27± ±1.27 *** 15.47±1.51 ** 17.06±1.07 Femle ± ± 1.25 *** 15.29±1.33 *** 17.23±0.75 Totl 12.65± ±1.15 *** 11.94±1.46 *** 15.19±1.13 ABH Mle 12.16± ± ±1.29 *** 14.76±1.23 C5 Femle 12.98± ±1.21 *** 12.47±1.40 *** 15.47±0.98 Totl 15.19± ±1.33 *** 15.18±1.27 *** 17.13±0.89 PBH Mle 15.11± ±1.59 *** 15.12±1.31 *** 17.06±1.07 Femle 15.25± ± 1.15 *** 15.22±1.26 *** 17.18±0.77 Totl 5.97± ±1.50 *** 6.39±1.81 *** 3.64±1.19 AIS Mle 6.52 ± ± ±1.38 *** 4.09±1.40 C2 C3 Femle 5.60± ±1.44 *** 5.77±1.90 *** 3.34±0.95 Totl 4.29± ±1.36 *** 4.21±1.46 *** 3.04±1.03 PIS Mle 4.37± ± ± ±1.13 Femle 4.24± ±1.42 *** 4.05±1.17 ** 2.29±0.96 Totl 6.14± ±1.54 *** 6.54±1.62 *** 3.63±1.13 AIS Mle 6.62± ±0.72 *** 7.04±1.52 *** 4.01±1.33 C3 C4 Femle 5.81± ±1.77 *** 6.12±1.61 *** 3.38±0.92 Totl 3.76± ±1.53 *** 3.40± ±1.07 PIS Mle 3.99± ±1.35 *** 3.38± ±1.21 Femle 3.60± ±1.50 ** 3.42± ±0.96 Totl 5.54± ±1.49 *** 5.96±1.51 *** 3.48±1.12 AIS Mle 6.19± ±1.34 * 6.73±0.93 *** 3.97±1.25 C4 C5 Femle 5.08± ±1.40 ** 5.34±1.61 *** 3.16±0.91 Totl 3.69± ±1.30 *** 3.28± ±1.06 PIS Mle 3.76± ±1.57 *** 3.21± ±1.21 Femle 3.65± ±1.07 *** 3.34± ±0.96 ANOVA; b Student s t-test; Significnt gender difference p<0.05; Significnce level t * p<0.05, ** p<0.01, *** p<0.001 Tble 6. Percentge of nterior nd posterior C2, C3, C4, C5 body heights sum compred to totl nterior nd posterior height of C2 C5 prt % ABH C/AH C2 C5 % PBH C/PH C2 C5 Vrible I vs II vs III I vs II vs III Gender b Mle 74.82±2.40 ** 79.08±2.62 ** 87.93± ±3.48 ** 89.01± ±3.25 Totl 76.68±3.55 ** 81.11±4.31 ** 89.24± ±3.20 ** 89.11±3.33 ** 91.62±2.46 Femle 77.81±3.68* ** 82.78±4.75* ** 90.12±2.41* 84.63±2.92 ** 89.19±2.95 ** 91.92±1.78 ANOVA; b Student s t-test * p<0.05; ** p<0.01 doi: /SARH L

6 Srp Arh Celok Lek Nov-Dec;143(11-12): height C3 nd posterior height C5, nterior intervertebrl spce C3 C4 nd posterior C4 C5 were greter in femles, but without sttisticl significnce, in the beginning of pubertl growth, while nterior body height C3 ws greter in femles with ccelerted growth only. The results of the Altn et l. [2] longitudinl study, which included Turkish girls ged eight to 17 yers, showed tht the growth of the vertebre hd its pek t round 13.5 yers of ge, immeditely before the s4 stge of cervicl mturity. The slowing of the process strted t round 15.5 yers of ge, but nterior vertebre growth stopped t round the ge of 16.5 (s6). Mito et l. [25] nlyzed vertebre growth in Jpnese eight- to 14-yer-old girls, nd concluded tht in girls, ccelerted growth of the nterior nd posterior body height existed between the ges of 10 nd 13. In our study, greter liner growth ws present mostly between the group of 12- nd 13-yer-olds nd the group of 17- nd 18-yer-olds. Due to possible differences in the ptients body constitution, s well s individul vritions during growth, we wnted to show in our study the percentul presence of vertebre nd intervertebrl spces in ddition to liner mesures nd how their reltionship chnged in different ge periods. The study showed tht body growth of the vertebr C2 is different thn tht of vertebre C3, C4 nd C5. It ws determined tht the biggest prt of the cervicl spine is the vertebr C2. The rest ws eqully distributed with vertebre C3, C4 nd C5 (Tble 5). With ge, percentge of nterior nd posterior body height of the vertebr C2 ws decresed in totl length, while nterior nd posterior body heights of the vertebre C3, C4 nd C5 ws incresed. The percentge of intervertebrl spces ws decresed s well. Higher percentge of vertebr C2 ws found in femles, except t the ges of 12 nd 13. Anterior nd posterior C3, C4 nd C5 body heights occupied more spce in femles, except for posterior body height of the vertebr C4 t the ges of 12 nd 13. With ge, their nterior nd posterior side occupied greter percent nd posterior side ws greter thn the nterior in ll three ge groups (Tble 5). It ws noted tht nterior nd posterior intervertebrl spce height decresed with greter vlues in mles, except for the posterior intervertebrl spce C2 C3 height t the ge of eight, nd for the nterior intervertebrl spce C3 C4 nd C4 C5 height t the ges of 12 nd 13. This study demonstrted tht the vertebr C2 ws the biggest, but grew slowly, nd tht intervertebrl spces were reduced due to growth of vertebrl bodies. Femles showed greter presence of nterior nd posterior body height of ll vertebre in totl length, while intervertebrl spces were smller. This mens tht femles hd higher percentge of vertebrl body presence, while mles hd more intervertebrl spces. Percentge-wise, the totl sum of nterior nd posterior C2, C3, C4 nd C5 body heights incresed in growth nd took up more spce in C2 C5 height regrdless of sex. At the ge of eight, nterior height of ll vertebre (C2 C5) occupied bout 75% in totl length, while the posterior one occupied round 85%. At the ges of 12 nd 13, the nterior height ws bout 80% nd the posterior one ws 90%. At the ges of 17 nd 18, nterior height occupied bout 90%, the sme s posterior. Thus, the sum of ll nterior body heights incresed round 15%, while the sum of the posterior heights incresed bout 5% (Tble 6). The percentge of nterior nd posterior body height sum compred to totl C2 C5 height showed positive correltion between cervicl lordosis, while the percentge of nterior nd posterior intervertebrl spces height sum compred to totl C2 C5 height showed negtive correltion (Tble 3). Accordingly, these chnges were monitored more esily if the sum of ll nterior heights ws tken into ccount. Lrger chnges of nterior vertebrl dimensions indicte the possibility for esier growth curve detection (the puberty onset, growth spurt, mximum growth nd decrese of the growth intensity). Some of the studies consider tht CVM method is subjective nd should be used in combintion with some other prmeter tht estimtes skeletl mturity [1, 2, 13-16]. Our reserch offers the percentge of nterior body heights of vertebre C2, C3, C4 nd C5 sum compred to totl nterior C2 C5 prt of the spine, s possible skeletl mturity estimtion. Our study is designed s cross-sectionl study, which might hve its limittions. To ccurtely determine the chnges in cervicl lordosis nd cervicovertebrl morphology t different ge nd the possibility of estimting skeletl mturity, it is necessry to perform longitudinl studies, or obtin the vlues for every yer of ptient s life. Further growth reserches re necessry to determine the growth curve nd exct percentge rtio of the cervicl vertebrl bodies to the totl length of the mesured spine. Limittions in inclusion criteri, necessity of repeted rdiogrphic exmintions nd potentil loss of subjects for follow-up mke such studies difficult to perform. CONCLUSION Cervicl lordosis lters during growth nd is more curved in femles. The connection ws observed between cervicl lordosis nd the vlues of C3, C4, nd C5 body heights nd intervertebrl spces. Anterior nd posterior vertebre body height increse, nd intervertebrl spces decrese in older ge groups, nd they re lrger in 17- to 18-yer-old mles compred to femles of the sme ge. Vertebrl body height nd spces between them chnge their percentge rtio with growth. The percentul presence of vertebr C2 body height nd intervertebrl spces decrese nd the percentul presence of vertebre C3, C4, nd C5 increse in older ge groups. Vertebrl bodies occupy more spce of the spine in femles, while intervertebrl spces occupy more of this spce in mles. It might be expected tht skeletl mturity cn be estimted by determining percentge distribution of nterior C2, C3, C4 nd C5 body height sum compred to the totl nterior C2 C5 spine prt. This percentge rtio should be used with some other prmeters in estimtion of skeletl mturity.

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Циљ ра да Циљ ове сту ди је је био да се уоче про ме не криви не врат не кич ме и мор фо ло ги је врат них пр шље но ва у раз ли чи тим уз ра сним гру па ма, као и мо гућ ност про це не ске лет не зре ло сти за сно ва не на про цен ту ал ној за сту пљено сти зби ра пред њих ви си на врат них пр шље но ва Ц2, Ц3, Ц4 и Ц5 у укуп ној ду жи ни пред ње ви си не кич ме од Ц2 до Ц5. Ме то де ра да Сту ди ја је об у хва ти ла 120 ис пи та ни ка оба пола ко ји су свр ста ни у три ста ро сне гру пе: 8, и го ди на. Пет кра ни јал них и 15 цер ви кал них па ра ме та ра је ме ре но и ана ли зи ра но. Ре зул та ти Ре зул та ти су по ка за ли ста ти стич ки зна чај ну коре ла ци ју из ме ђу за кри вље но сти врат не кич ме и го ди на, пола, пред ње и зад ње ви си не те ла пр шље на Ц2, Ц3, Ц4, предњег Ц4 Ц5 и зад њег Ц2 Ц3, Ц3 Ц4, Ц4 Ц5 ме ђу пр шљенског про сто ра. Про сеч не вред но сти ви си не те ла врат них пр шље но ва про цен ту ал но су би ле че шће код ис пи та ни ца, а сви ме ђу пр шљен ски про сто ри код осо ба му шког по ла. Проце нат зби ра пред ње и зад ње ви си не пр шље на Ц2, Ц3, Ц4 и Ц5 по ве ћа вао се са го ди на ма. За кљу чак Кри ви на врат не кич ме по ста је за кри вље ни ја и те ла пр шље но ва за у зи ма ју ви ше про сто ра код же на, а међу пр шљен ски про стор ви ше код му шка ра ца. Про це на скелет не зре ло сти би мо гла да се пра ти на осно ву про цен ту алне за сту пље но сти ви си не те ла пр шље на у укуп ној ду жи ни пред њег де ла кич ме (Ц2 Ц5). Кључ не ре чи: кич ме на кри ви на; лор до за; раст; са зре ва ње Примљен Received: 13/02/2015 Прихваћен Accepted: 14/04/2015 doi: /SARH L