Key imaging features are useful to differentiate between traumatic fractures and normal or variant anatomy acutely however, the radiologist must first have a basic understanding of the spectrum of normal developmental anatomy and its anatomic variations in order to make an accurate assessment. At times, it is necessary to distinguish normal development, developmental variants, and developmental anomalies from traumatic injuries in the setting of acute traumatic injury. The most common congenital variations of the dens include the os odontoideum and a persistent ossiculum terminale. In addition, congenital anomalies are common in this region, especially those associated with the axis/dens, due to its complexity in terms of development compared to other vertebral levels. The biomechanics of the developing pediatric spine and age-related degenerative changes predispose these patient populations to injuries centered at the craniocervical junction.
Accurate interpretation of cervical spine imagining can be challenging, especially in children and the elderly.
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