A systematic review of methods to determine skeletal maturation based on cervical vertebrae

Introduction: Since the determination of skeletal maturation by surveying concavity on lower surface of cervical vertebrae and evaluating shape of vertebrae is a subjective and quantitative study, this systematic review was performed to evaluate new quantitative and objective methods by using cervical vertebrae for determining skeletal maturation. Material and Methods: Related keywords were searched in Pubmed and Cochran database in order to find studies that were published in English from January 2000 to January 2019 and evaluated skeletal maturation based on cervical vertebrae by modern methods. Also, the references of the included studies were search for other related studies. Results: From overall 1371 titles, 27 were selected by initial screening. Evaluation of the full texts resulted in inclusion of 13 articles. Among articles included in this review, three studies used CBCT images and another studies used lateral cephalogram. One study performed evaluation cervical vertebrae in the axial view of CBCT images while another evaluation was on sagittal view. Most of the studies used a regression model in order to determine bone age of vertebrae and then compared it with skeletal age obtained from hand wrist radiography. Conclusion: As the methods and measurements were different in the included studies it was not possible to reach a decisive conclusion regarding method for determining skeletal age based on cervical vertebrae. It is suggested to use a combination of maturation signs along with development stages of cervical vertebrae in order to determine skeletal maturation until a quantitative and valid method is presented.