contribute to hypoplasia of the dens. The proximal physis develops a secondary ossification center when the child is 8-10 years old – the ossicle terminale. Fusion of this to the rest of the dens occurs at age 10-13.
– note: the neurocentral synchondrosis DOES NOT contribute significantly to the vertical growth of the dens. It comes from the other end (the tip).
– C-spine injuries in young children 10 (whether symptomatic or not) or if they have any instability with neurologic signs and or symptoms (neck pain, stiff neck, torticollis, progressive weakness, decreasing endurance, loss of bowel or bladder control, clumsiness, change in gait pattern.)