CT evaluation of pediatric craniocervical distraction injuries: a comprehensive review of morphometric parameters and practical applications

Craniocervical distraction injuries in children are uncommon but can be fatal, often resulting from high-impact trauma. Because these injuries predominantly affect ligaments, CT findings may be subtle or may occur without obvious fracture or malalignment. This review consolidates the relevant anatomy and key CT-based morphometric parameters essential for recognizing such injuries, including the basion-dens interval, Occipital condyle-C1 interval, atlanto-dental interval, and interspinous ratio. The article integrates normative data and updated measurement thresholds from recent literature, emphasizing their age-related variability and diagnostic implications. The purpose of this review is to provide pediatric radiologists with a consolidated resource that integrates the latest CT measurements and interpretive guidelines for quick and reliable consultation. By improving awareness of subtle quantitative deviations and anatomical nuances, this review aims to enhance diagnostic accuracy and promote early recognition of potentially unstable craniocervical injuries in pediatric trauma assessment.