Cervical vertebral body growth and emergence of sexual dimorphism: a developmental study using computed tomography

Courtney A. Miller, Seong Jae Hwang, Meghan M. Cotter, Houri K. Vorperian

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9 Citations (Scopus)


The size and shape of human cervical vertebral bodies serve as a reference for measurement or treatment planning in multiple disciplines. It is therefore necessary to understand thoroughly the developmental changes in the cervical vertebrae in relation to the changing biomechanical demands on the neck during the first two decades of life. To delineate sex-specific changes in human cervical vertebral bodies, 23 landmarks were placed in the midsagittal plane to define the boundaries of C2 to C7 in 123 (73 M; 50 F) computed tomography scans from individuals, ages 6 months to 19 years. Size was calculated as the geometric area, from which sex-specific growth trend, rate, and type for each vertebral body were determined, as well as length measures of local deformation-based morphometry vectors from the centroid to each landmark. Additionally, for each of the four pubertal-staged age cohorts, sex-specific vertebral body wireframes were superimposed using generalized Procrustes analysis to determine sex-specific changes in form (size and shape) and shape alone. Our findings reveal that C2 was unique in achieving more of its adult size by 5 years, particularly in females. In contrast, C3–C7 had a second period of accelerated growth during puberty. The vertebrae of males and females were significantly different in size, particularly after puberty, when males had larger cervical vertebral bodies. Male growth outpaced female growth around age 10 years and persisted until around age 19–20 years, whereas females completed growth earlier, around age 17–18 years. The greatest shape differences between males and females occurred during puberty. Both sexes had similar growth in the superoinferior height, but males also displayed more growth in anteroposterior depth. Such prominent sex differences in size, shape, and form are likely the result of differences in growth rate and growth duration. Female vertebrae are thus not simply smaller versions of the male vertebrae. Additional research is needed to further quantify growth and help improve age- and sex-specific guidance in clinical practice.

Original languageEnglish
Pages (from-to)764-777
Number of pages14
JournalJournal of Anatomy
Issue number6
Publication statusPublished - 2019 Jun

Bibliographical note

Funding Information:
This research was funded, in part, by National Institutes of Health Grant R01 DC6282 from the National Institute on Deafness and Other Communicative Disorders (NIDCD), and Core Grants P30 HD03352 and U54 HD090256 from the National Institute of Child Health and Human Development (NICHD). There was no involvement of the funding sources in the research design, data collection, analysis, interpretation, writing of this paper or the submission for publication. All authors declare there was no conflict of interest in the research reported in this study/paper. We thank Ellie Fischer and Anna Buchholz for assistance in landmark placement, and Moo K. Chung for statistical consultation. We also thank Drs. Edward Bersu, Jacqueline Houtman, and four anonymous reviewers for their comments on earlier versions of this paper that greatly enhanced its accuracy and clarity.

Publisher Copyright:
© 2019 Anatomical Society

All Science Journal Classification (ASJC) codes

  • Anatomy
  • Histology
  • Ecology, Evolution, Behavior and Systematics
  • Molecular Biology
  • Developmental Biology
  • Cell Biology


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