New anatomical data on the growing C4 vertebra and its three ossification centers in human fetuses

PURPOSE: Detailed knowledge on the normative growth of the spine is of great relevance in the prenatal diagnosis of its abnormalities. The present study was conducted to compile age-specific reference data for vertebra C4 and its three ossification centers in human fetuses. MATERIALS AND METHODS: With the use of CT (Biograph mCT), digital image analysis (Osirix 3.9) and statistical analysis (Wilcoxon signed-rank test, Kolmogorov–Smirnov test, Levene’s test, Student’s t test, one-way ANOVA, post hoc RIR Tukey test, linear and nonlinear regression analysis), the normative growth of vertebra C4 and its three ossification centers in 55 spontaneously aborted human fetuses (27 males, 28 females) aged 17–30 weeks was examined. RESULTS: Significant differences in neither sex nor laterality were found. The height and transverse and sagittal diameters of the C4 vertebral body increased logarithmically as: y = −3.866 + 2.225 × ln(Age) ± 0.238 (R (2) = 0.69), y = −7.077 + 3.547 × ln(Age) ± 0.356 (R (2) = 0.72) and y = −3.886 + 2.272 × ln(Age) ± 0.222 (R (2) = 0.73), respectively. The C4 vertebral body grew linearly in cross-sectional area as y = −7.205 + 0.812 × Age ± 1.668 (R (2) = 0.76) and four-degree polynomially in volume as y = 14.108 + 0.00007 × Age(4) ± 6.289 (R (2) = 0.83). The transverse and sagittal diameters, cross-sectional area and volume of the ossification center of the C4 vertebral body generated the following functions: y = −8.836 + 3.708 × ln(Age) ± 0.334 (R (2) = 0.76), y = −7.748 + 3.240 × ln(Age) ± 0.237 (R (2) = 0.83), y = −4.690 + 0.437 × Age ± 1.172 (R (2) = 0.63) and y = −5.917 + 0.582 × Age ± 1.157 (R (2) = 0.77), respectively. The ossification center-to-vertebral body volume ratio gradually declined with age. On the right and left, the neural ossification centers showed the following growth: y = −19.601 + 8.018 × ln(Age) ± 0.369 (R (2) = 0.92) and y = −15.804 + 6.912 × ln(Age) ± 0.471 (R (2) = 0.85) for length, y = −5.806 + 2.587 × ln(Age) ± 0.146 (R (2) = 0.88) and y = −5.621 + 2.519 × ln(Age) ± 0.146 (R (2) = 0.88) for width, y = −9.188 + 0.856 × Age ± 2.174 (R (2) = 0.67) and y = −7.570 + 0.768 × Age ± 2.200 (R (2) = 0.60) for cross-sectional area, and y = −13.802 + 1.222 × Age ± 1.872 (R (2) = 0.84) and y = −11.038 + 1.061 × Age ± 1.964 (R (2) = 0.80) for volume, respectively. CONCLUSIONS: The morphometric parameters of vertebra C4 and its three ossification centers show no sex differences. The C4 vertebral body increases logarithmically in height and both sagittal and transverse diameters, linearly in cross-sectional area, and four-degree polynomially in volume. The three ossification centers of vertebra C4 grow logarithmically in both transverse and sagittal diameters, and linearly in both cross-sectional area and volume. The age-specific reference intervals for evolving vertebra C4 may be useful in the prenatal diagnosis of congenital spinal defects.