X-RAY evaluation of the 3RD 4th and 5TH cervical vertebrae for age determination

Objective: Identification is a crucial area of practice in forensic medicine. One of the important steps in figuring out the medical identity is age determination. Hand-wrist x-rays are frequently used in practice for this purpose. However, in recent years, the number of studies on determining bone age with different methods has been increasing. This study aims to develop a regression formula to be used in age estimation by making metric measurements and proportions on lateral cervical radiography images of individuals aged 5-18 years and to evaluate the applicability of cervical vertebra maturation stages in forensic age estimation using the Bacetti staging system. Materials and Methods: In our study, we retrospectively evaluated the radiographs of patients aged 5 to 18 who applied to the Department of Pediatric Radiology at Ankara University between January 2016 and December 2021. The study involved 420 persons in total, 15 boys and 15 girls, 30 from each age group. Anteroposterior margin height, diagonal diameter, concavity depth and anterior-posterior length of the 3rd, 4th and 5th cervical vertebral bodies were measured and ratios were evaluated. The Bacetti technique was used to assess the stages of cervical vertebral development. Results: Based on the findings of our study, we developed a regression formula to estimate the age of cervical vertebral bones. Age of males = -6,471+ (7,004 x AH3/PH3) + (20,665 x CONC3/AP3) + (9,676 x AH4/PH4)) + (7,483 x AH5/DH5 ) Age of females = -6,397+ (6,726 x AH3/PH3) + (9,710 x AH4/PH4) + (7,559 x AH5/DH5) + (17,342 x CONC4/AP4 ) In our evaluation of the presence-absence of concavity for the 3rd, 4th and 5th cervical vertebrae; the highest age without concavity in all three vertebrae was found to be 7, and the earliest age with concavity in all three vertebrae was 15. According to Bacetti's 5-stage system, it was observed that Stage 2–3 individuals are over 7 years old, Stage 4 individuals are over 11 years old, Stage 5 individuals are over 12 years old, Stage 1 individuals are under 14 years old, Stage 2 individuals are under 15 years old, females reach all stages earlier than males, cervical vertebrae development is compatible with chronological age, and can be used in forensic age estimation. Conclusions: In forensic age estimation, more precise findings are obtained when methods increase and several methods are assessed together. Cervical vertebral development stages seem to be applicable in forensic age estimation either by qualitative or quantitative measurement methods. However, there is a need for prospective studies with larger sample sizes in which socioeconomic level, height-weight, and demographic characteristics data are evaluated in more detail in the model developed for the Turkish society. Key Words: Forensic age estimation, cervical vertebra, Bacetti method